Healthcare Provider Details

I. General information

NPI: 1699017152
Provider Name (Legal Business Name): REIESHA D GRAHAM M.D. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REIESHA D ROBBINS MD PHD

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 06/21/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WELLNESS WAY STE 300
MILFORD DE
19963-4366
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-424-6511
  • Fax: 302-424-6513
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB10182800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC10024711
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: