Provider Demographics
NPI:1043249386
Name:MCGRAW, JOHN MELBOURNE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MELBOURNE
Last Name:MCGRAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 MARIA LN
Mailing Address - Street 2:STE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5343
Mailing Address - Country:US
Mailing Address - Phone:925-944-3434
Mailing Address - Fax:
Practice Address - Street 1:21655 BIDEN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4573
Practice Address - Country:US
Practice Address - Phone:302-604-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA496932084P0800X
DEC1-00134532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A496930Medicare ID - Type Unspecified
CAF12447Medicare UPIN