Provider Demographics
NPI:1114607009
Name:GRAHAM, MARK A
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KRAMERS POND RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-2609
Mailing Address - Country:US
Mailing Address - Phone:914-498-8617
Mailing Address - Fax:
Practice Address - Street 1:8 KRAMERS POND RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-2609
Practice Address - Country:US
Practice Address - Phone:914-498-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company