Provider Demographics
NPI:1184861627
Name:GRAHAM, KATHARINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 OLD LANCASTER RD
Mailing Address - Street 2:STE 105N
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:610-527-1165
Mailing Address - Fax:610-527-6611
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:STE 105N
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-527-1165
Practice Address - Fax:610-527-6611
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0014121363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA0014121OtherMEDICAL LICENSE