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General NPI Number Information
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NPI Number | 1043287220
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Entity Type | Individual
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Provider Name | MATTHEW TIMOTHY GRAHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 203 MILLS AVE
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City | GREENVILLE
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State | SC
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Zip | 29605-4019
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Country | US
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Telephone | 864-271-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 203 MILLS AVE
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City | GREENVILLE
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State | SC
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Zip | 29605-4019
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Country | US
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Telephone | 864-271-1844
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD27447
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 24329
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24329
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License Number State | SC
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