Healthcare Provider Details

I. General information

NPI: 1629127774
Provider Name (Legal Business Name): TERRI MARIE GRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI GRAHAM SMITH MD

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 MERIDIAN AVE N SUITE 210
SEATTLE WA
98133-9451
US

IV. Provider business mailing address

10330 MERIDIAN AVE N SUITE 210
SEATTLE WA
98133-9451
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-6080
  • Fax: 206-368-6088
Mailing address:
  • Phone: 206-368-6080
  • Fax: 206-368-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00030161
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD00030161
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: