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General NPI Number Information
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NPI Number | 1629299342
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Entity Type | Organization
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Legal Business Name | ANTHONY W. GRAHAM, M.D., P.L.L.C..
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 509 4TH AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2824
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Country | US
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Telephone | 304-727-6270
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Fax | 304-727-6271
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Provider Business Mailing Address
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Address Line | 509 4TH AVE
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2824
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Country | US
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Telephone | 304-727-6270
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Fax | 304-727-6271
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. ANTHONY W. GRAHAM
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Credential | M.D.
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Telephone | 304-727-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 09628
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License Number State | WV
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