Provider Demographics
NPI:1144301086
Name:GRABENSTEIN, THOMAS G (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:GRABENSTEIN
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:KY
Mailing Address - Zip Code:42220-0277
Mailing Address - Country:US
Mailing Address - Phone:270-265-5600
Mailing Address - Fax:270-265-5600
Practice Address - Street 1:810 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-8812
Practice Address - Country:US
Practice Address - Phone:270-265-5600
Practice Address - Fax:270-265-5605
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35531OtherMEDICAL LICENSE
KY7100266190Medicaid
TN12341OtherMD LICENSE