Provider Demographics
NPI:1487628533
Name:GRAHAM, TOBY JO O (MD)
Entity Type:Individual
Prefix:DR
First Name:TOBY JO
Middle Name:O
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOBY
Other - Middle Name:O
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:MEZZANINE LEVEL C WING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2546
Mailing Address - Country:US
Mailing Address - Phone:412-648-9130
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:MEZZANINE LEVEL C WING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2546
Practice Address - Country:US
Practice Address - Phone:412-648-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012471E174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000688254Medicaid
PA006449Medicare PIN
PA000688254Medicaid
PA006449D8RMedicare ID - Type Unspecified