Organization
GRAVES DERMA CARE CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAUGHAN CHANNING GRAVES M.D. (CEO PRESIDENT)
(215) 879-2389
Entity
Organization
Contact information
Practice address
601 WALNUT ST, SUITE L90, PHILADELPHIA, PA 19106-3304
(215) 238-1622
(215) 238-1944
Mailing address
601 WALNUT ST, SUITE L90, PHILADELPHIA, PA 19106-3304
(215) 238-1622
(215) 238-1944
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD 028158E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009410580004
—
PA
Enumeration date
01/02/2007
Last updated
05/20/2008
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