Provider Demographics
NPI:1447328018
Name:GRACIA, ANNE-MARIE GIZELLE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:GIZELLE
Last Name:GRACIA
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 3122
Mailing Address - Street 2:MEMORIAL STATION
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-3122
Mailing Address - Country:US
Mailing Address - Phone:973-243-0220
Mailing Address - Fax:973-243-2441
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5341
Practice Address - Country:US
Practice Address - Phone:973-243-0220
Practice Address - Fax:973-243-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-03-21
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Provider Licenses
StateLicense IDTaxonomies
NJMA58440207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6560610Medicaid
NJ6560610Medicaid
NJ707706Medicare PIN