Provider Demographics
NPI:1245212307
Name:GRAHAM, ROGER WINFIELD (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:WINFIELD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 AIRPORT WAY S STE 200
Mailing Address - Street 2:QUEST DIAGNOSTICS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1636
Mailing Address - Country:US
Mailing Address - Phone:206-623-8100
Mailing Address - Fax:
Practice Address - Street 1:1737 AIRPORT WAY S STE 200
Practice Address - Street 2:QUEST DIAGNOSTICS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1636
Practice Address - Country:US
Practice Address - Phone:206-623-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021129207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
66863OtherWA ST LABOR INDUSTRIES
81407OtherWA ST LABOR INDUSTRIES
WA8153462Medicaid
WA8153462Medicaid
A49581Medicare UPIN
001060907Medicare ID - Type Unspecified