1275677965 NPI number — EMMANUEL S. GRAHAM MD

Table of content: EMMANUEL S. GRAHAM MD (NPI 1275677965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275677965 NPI number — EMMANUEL S. GRAHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM
Provider First Name:
EMMANUEL
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275677965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00823-6883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-719-8761
Provider Business Mailing Address Fax Number:
340-719-8764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4F-5F SUNNY ISLES PROFESSIONAL BUILDING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-719-8761
Provider Business Practice Location Address Fax Number:
340-719-8764
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  1455 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002-8793 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com