Healthcare Provider Details

I. General information

NPI: 1144429556
Provider Name (Legal Business Name): DIANA RACHEL GRAHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

IV. Provider business mailing address

107 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-1260
  • Fax: 919-747-0551
Mailing address:
  • Phone: 919-250-1260
  • Fax: 919-747-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2007-01175
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: