Provider Demographics
NPI:1497933683
Name:GRAHAM, TIMUR TAFARI (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMUR
Middle Name:TAFARI
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PLYMOUTH AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-4300
Mailing Address - Country:US
Mailing Address - Phone:508-679-4239
Mailing Address - Fax:508-679-3702
Practice Address - Street 1:203 PLYMOUTH AVE STE 702
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4300
Practice Address - Country:US
Practice Address - Phone:508-679-4239
Practice Address - Fax:508-679-3702
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273387207RP1001X
CT047772207R00000X
NH20565207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001477728Medicaid
CTD400004160 - C00023Medicare PIN
CTD400004165 - C00814Medicare PIN