MEDICARE: DR. MAURICE E GRAHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101033033	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003883695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE E GRAHAM M.D.

Provider Business Mailing Address
First Line	:	4374 NEW TOWN AVE
Second Line	:	STE 202
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2865
Country	:	US
Telephone Number	:	757-253-5757
Fax Number	:	757-510-9063

Provider Business Practice Location Address
First Line	:	4374 NEW TOWN AVE
Second Line	:	STE 202
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2865
Country	:	US
Telephone Number	:	757-253-5757
Fax Number	:	757-510-9063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	01/10/2012

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