Healthcare Provider Details

I. General information

NPI: 1568535003
Provider Name (Legal Business Name): SARA S GRAHAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MCCONNELL DR
COLUMBUS OH
43214-3463
US

IV. Provider business mailing address

5400 FRANTZ RD STE 250
DUBLIN OH
43016-4144
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5377
  • Fax:
Mailing address:
  • Phone: 614-544-6161
  • Fax: 614-566-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34009679
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number34.009679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: