Healthcare Provider Details

I. General information

NPI: 1962437178
Provider Name (Legal Business Name): JULIANNE P GRAHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

PO BOX 845398
BOSTON MA
02284-5398
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-5252
  • Fax:
Mailing address:
  • Phone: 888-447-2450
  • Fax: 405-844-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0485
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: