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General NPI Number Information
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NPI Number | 1043213960
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Entity Type | Individual
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Provider Name | CHARLES DUDLEY GRAHAM MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 2910 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9350
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Country | US
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Telephone | 843-572-9211
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Fax | 843-572-0457
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Provider Business Mailing Address
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Address Line | 2910 TRICOM ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9350
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Country | US
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Telephone | 843-572-9211
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Fax | 843-572-0457
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 11628
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License Number State | SC
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