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NPI Code Detail

MEDICARE: PHILIP DOUGLAS GRAHAM PA

MEDICARE: PHILIP DOUGLAS GRAHAM PA
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
1363AS0400XSurgical Physician Assistant012180NY
2363A00000XPhysician Assistant012180NY

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 : 1922289107
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP DOUGLAS GRAHAM PA
Provider Business Mailing Address
First Line : PO BOX 505
Second Line :
City : NORTH CHILLI
State : NY
Zip : 14514-0505
Country : US
Telephone Number : 585-594-5995
Fax Number : 585-594-5425
Provider Business Practice Location Address
First Line : 4201 BUFFALO ROAD
Second Line : SUITE 1
City : NORTH CHILI
State : NY
Zip : 14514-1256
Country : US
Telephone Number : 585-594-5995
Fax Number : 585-594-5995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2007
Last Update Date : 07/18/2023

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Directions to “ PHILIP DOUGLAS GRAHAM PA” Practice Location

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