Healthcare Provider Details

I. General information

NPI: 1760682298
Provider Name (Legal Business Name): CLAUDIA GRAHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA ANN GRAHAM

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 HOOSICK ST STE K
TROY NY
12180-2393
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-5370
  • Fax:
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number335239
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF3352391
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number335239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: