Individual
JAY ALLAN GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19 HALLS RD, OLD LYME, CT 06371-1457
(860) 434-8300
Mailing address
19 HALLS RD, OLD LYME, CT 06371-1457
(860) 434-8300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
020499
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001204999
—
CT
Enumeration date
01/02/2007
Last updated
11/16/2009
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