Healthcare Provider Details

I. General information

NPI: 1265598148
Provider Name (Legal Business Name): GRAHAM MEDICAL CLINIC,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S HIGH ST
NEWVILLE PA
17241-1409
US

IV. Provider business mailing address

100 S HIGH ST
NEWVILLE PA
17241-1409
US

V. Phone/Fax

Practice location:
  • Phone: 717-776-3114
  • Fax: 717-776-6003
Mailing address:
  • Phone: 717-776-3114
  • Fax: 717-776-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAY A TOWNSEND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 717-776-3114