Healthcare Provider Details

I. General information

NPI: 1194653725
Provider Name (Legal Business Name): ALFRED GRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 N ST NW UNIT 333
WASHINGTON DC
20001-3599
US

IV. Provider business mailing address

57 N ST NW UNIT 333
WASHINGTON DC
20001-3599
US

V. Phone/Fax

Practice location:
  • Phone: 202-470-7600
  • Fax:
Mailing address:
  • Phone: 202-470-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number9575451
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: