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NPI Code Detail

MEDICARE: DR. CHARLES DUDLEY GRAHAM MD

MEDICARE: DR. CHARLES DUDLEY GRAHAM MD
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
1207RH0003XHematology & Oncology Physician11628SC

Other Identifiers

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

General Provider Information

NPI Number : 1043213960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES DUDLEY GRAHAM MD
Provider Business Mailing Address
First Line : 2910 TRICOM ST
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9350
Country : US
Telephone Number : 843-572-9211
Fax Number : 843-572-0457
Provider Business Practice Location Address
First Line : 2910 TRICOM ST
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9350
Country : US
Telephone Number : 843-572-9211
Fax Number : 843-572-0457
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 11/05/2009

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Directions to “ DR. CHARLES DUDLEY GRAHAM MD” Practice Location

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