Provider Demographics
NPI:1407853872
Name:GRAHAM, SUSAN BRANDT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BRANDT
Last Name:GRAHAM
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Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4705 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1246
Mailing Address - Country:US
Mailing Address - Phone:505-884-9488
Mailing Address - Fax:505-884-7059
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:STE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1246
Practice Address - Country:US
Practice Address - Phone:505-884-9488
Practice Address - Fax:505-884-7059
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86-237207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME938809Medicare UPIN