MEDICARE: DR. RICHARD W GRAHAM M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	0101 033452	VA
2	208800000X	Urology Physician	042-0012170	VT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	340001591	OTHER	VA	RAILROAD MEDICARE
16	002130301	OTHER		MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	24388	OTHER	VA	ALLIANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	59294	OTHER	VA	SOUTHERN HEALTH
5	2582	OTHER	VA	CIGNA
7	447989	OTHER	VA	SOUTHERN HEALTH EFF111506
8	45722	OTHER	VA	SENTARA FAMILY CARE
9	1900011	OTHER	VA	UNITED HEALTHCARE
10	36538	OTHER	VA	CARENET
11	3762531	OTHER	VA	AETNA HMO
12	4063408	OTHER	VA	AETNA PPO
13	497602109	OTHER	VA	TRICARE
14	247815	OTHER	VA	ANTHEM BCBS
15	3016615	OTHER	VT	MVP
17	1478176	OTHER	VT	CIGNA
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	642070000-00	OTHER	VA	QUALCHOICE
20	66241	OTHER	VA	CARENET EFF 111506

NPI Number	:	1225092794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD W GRAHAM M.D.

Provider Business Mailing Address
First Line	:	44 S MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	VT
Zip	:	05060-1381
Country	:	US
Telephone Number	:	802-728-2372
Fax Number	:	802-728-2613

Provider Business Practice Location Address
First Line	:	108 N MAIN ST
Second Line	:
City	:	WHITE RIVER JUNCTION
State	:	VT
Zip	:	05001-7056
Country	:	US
Telephone Number	:	802-296-7370
Fax Number	:	802-296-7174

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/12/2011

128 N MAIN ST
WHITE RIVER JUNCTION, VT
05001-7056

Practice Phone: 802-295-3300
Practice Fax: 802-295-6581