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General NPI Number Information
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NPI Number | 1932592417
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Entity Type | Individual
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Provider Name | MARIE ELISE ROEBUCK GRAHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 800 COMMISSIONERS ROAD E CHILDREN'S HOSPITAL, LONDON HEALTH SCIENCES CENTRE
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City | LONDON
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State | ON
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Zip | N6A 5W9
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Country | CA
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Telephone | 902-473-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 800 COMMISSIONERS ROAD E, BOX 5010 CHILDREN'S HOSPITAL, LONDON HEALTH SCIENCES CENTRE
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City | LONDON
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State | ON
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Zip | N6A 5W9
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Country | CA
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Telephone |
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 015863
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License Number State | ZZ
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