MEDICARE: DAVID H GRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306048996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID H GRAHAM

Provider Business Mailing Address
First Line	:	7 SENECA ST
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-1312
Country	:	US
Telephone Number	:	607-324-1372
Fax Number	:	607-324-1374

Provider Business Practice Location Address
First Line	:	238 N MAIN ST
Second Line	:
City	:	WELLSVILLE
State	:	NY
Zip	:	14895-1046
Country	:	US
Telephone Number	:	585-593-0400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SUE KAYS
Credential	:
Telephone Number	:	607-324-1372

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	09/18/2007

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