Provider Demographics
NPI:1275563850
Name:GRAHAME, JASON A (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:GRAHAME
Suffix:
Gender:M
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 1:5501 GREENWICH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6540
Mailing Address - Country:US
Mailing Address - Phone:757-502-8570
Mailing Address - Fax:757-490-4878
Practice Address - Street 1:5501 GREENWICH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6540
Practice Address - Country:US
Practice Address - Phone:757-502-8570
Practice Address - Fax:757-490-4878
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001707363AM0700X
VA01110001707363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ00819Medicare UPIN
VA002820J90Medicare ID - Type Unspecified