Healthcare Provider Details

I. General information

NPI: 1295902823
Provider Name (Legal Business Name): GREAT VALLEY NEUROLOGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INDUSTRIAL BLVD SUITE 204
PAOLI PA
19301-1632
US

IV. Provider business mailing address

11 INDUSTRIAL BLVD SUITE 204
PAOLI PA
19301-1632
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6251
  • Fax: 610-644-1440
Mailing address:
  • Phone: 610-644-6251
  • Fax: 610-644-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS H GRAHAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 610-644-6251