Individual
DR. JACK G GRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
802 NEW HOLLAND AVE, SUITE 200, LANCASTER, PA 17602-2163
(717) 358-1305
(717) 291-9634
Mailing address
802 NEW HOLLAND AVE, SUITE 200, LANCASTER, PA 17602-2163
(717) 358-1305
(717) 291-9634
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD028611L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000696452001
—
PA
Enumeration date
05/27/2006
Last updated
07/03/2012
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