Provider Demographics
NPI:1467630020
Name:SCANLON, GRAHAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:C
Last Name:SCANLON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3853 ROSECRANS ST
Mailing Address - Street 2:SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8232
Mailing Address - Fax:619-542-4060
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8232
Practice Address - Fax:619-542-4060
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2012-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1015052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI893ZMedicare PIN