Provider Demographics
NPI:1326172545
Name:GRAHAM, PATRICIA MCINNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MCINNIS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4531 LAKE POINT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1825
Mailing Address - Country:US
Mailing Address - Phone:225-753-4444
Mailing Address - Fax:225-578-1147
Practice Address - Street 1:INFIRMARY ROAD STUDENT HEALTH CTR
Practice Address - Street 2:LSU
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-2401
Practice Address - Country:US
Practice Address - Phone:225-578-8774
Practice Address - Fax:225-578-1147
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA93306Medicaid