MEDICARE: ERNESTO J F GRAHAM MD PA

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127K4	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528161668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNESTO J F GRAHAM MD PA

Provider Business Mailing Address
First Line	:	PO BOX 296
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-0296
Country	:	US
Telephone Number	:	910-421-0010
Fax Number	:	828-538-4441

Provider Business Practice Location Address
First Line	:	1521 OWEN PARK LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3454
Country	:	US
Telephone Number	:	910-223-7420
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ERNESTO GRAHAM
Credential	:	MD
Telephone Number	:	910-223-7420

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/11/2021

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