Provider Demographics
NPI:1275930554
Name:GRAHAM, L. DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:DAVID
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 1:319 HOSPITAL DR STE 208
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1948
Mailing Address - Country:US
Mailing Address - Phone:276-656-2103
Mailing Address - Fax:276-336-3248
Practice Address - Street 1:319 HOSPITAL DR STE 208
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1948
Practice Address - Country:US
Practice Address - Phone:276-656-2103
Practice Address - Fax:276-336-3248
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22168208600000X
VA0101261221208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery