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NPI Code Detail

MEDICARE: AUTUMN C GRAHAM MD

MEDICARE: AUTUMN C 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
1207P00000XEmergency Medicine Physician35085236OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J8790001OTHERDCBLUE SHIELD
2P00350406OTHERDCRAILROAD MED
375859902OTHERMDBLUE SHIELD

General Provider Information

NPI Number : 1578567012
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN C GRAHAM MD
Provider Business Mailing Address
First Line : 330 S WEST ST
Second Line : APT 308
City : ALEXANDRIA
State : VA
Zip : 22314-5915
Country : US
Telephone Number : 703-254-7237
Fax Number :
Provider Business Practice Location Address
First Line : 110 IRVING ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20010-2976
Country : US
Telephone Number : 202-444-2116
Fax Number : 513-557-3332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 03/06/2008

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Directions to “ AUTUMN C GRAHAM MD” Practice Location

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