Provider Demographics
NPI:1235427246
Name:FOOSE, GRAHAM ALBERT (DO)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:ALBERT
Last Name:FOOSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2875
Mailing Address - Fax:717-334-3921
Practice Address - Street 1:455 S WASHINGTON ST STE 12
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2516
Practice Address - Country:US
Practice Address - Phone:717-339-2875
Practice Address - Fax:717-334-3921
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFF1190747207R00000X
PAOS016313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029184090004Medicaid
PA350311F6KMedicare PIN