Healthcare Provider Details

I. General information

NPI: 1780784173
Provider Name (Legal Business Name): LARRY A. GRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINCINNATI-BATAVIA PK
CINCINNATI OH
45244
US

IV. Provider business mailing address

3000 HOSPITAL DR
BATAVIA OH
45103-1921
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax: 513-753-2144
Mailing address:
  • Phone: 513-752-1555
  • Fax: 513-753-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35058952
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35058952
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: