Provider Demographics
NPI:1174011654
Name:GRAHAM, CHARLES RAYMOND III (MAC, LAC, DIPLA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:GRAHAM
Suffix:III
Gender:M
Credentials:MAC, LAC, DIPLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 IONA TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3413
Mailing Address - Country:US
Mailing Address - Phone:410-426-8223
Mailing Address - Fax:410-426-8223
Practice Address - Street 1:3025 IONA TER
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3413
Practice Address - Country:US
Practice Address - Phone:410-426-8223
Practice Address - Fax:410-426-8223
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist