Provider Demographics
NPI:1508558677
Name:GRAHAM, JACOB PHILIP (PA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PHILIP
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6960 PELHAM RISE
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9633
Mailing Address - Country:US
Mailing Address - Phone:585-775-9368
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:585-775-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical