Healthcare Provider Details

I. General information

NPI: 1649035510
Provider Name (Legal Business Name): MEG CARPENTER GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152-9477
US

IV. Provider business mailing address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152-9477
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax: 855-866-8710
Mailing address:
  • Phone: 443-383-9300
  • Fax: 855-866-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number241649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: