Provider Demographics
NPI:1497289326
Name:GRAHAM ROBINSON-FARAH MD PA
Entity Type:Organization
Organization Name:GRAHAM ROBINSON-FARAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON-FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-885-5669
Mailing Address - Street 1:818 HART LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4160
Mailing Address - Country:US
Mailing Address - Phone:631-885-5669
Mailing Address - Fax:
Practice Address - Street 1:818 HART LAKE ST
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-4160
Practice Address - Country:US
Practice Address - Phone:631-885-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty