Provider Demographics
NPI:1114915931
Name:GRAHAM, REED B (DPM)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 CANTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2632
Mailing Address - Country:US
Mailing Address - Phone:330-535-8202
Mailing Address - Fax:330-535-3065
Practice Address - Street 1:696 CANTON RD STE 1
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2632
Practice Address - Country:US
Practice Address - Phone:330-535-8202
Practice Address - Fax:330-535-3065
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-0002836213ES0103X
OH36-00-2836-G213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3139259Medicaid
OHU45498Medicare UPIN
OH0947220Medicaid