Provider Demographics
NPI:1508860990
Name:GRAHAM, THOMAS HILD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HILD
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 1:11 INDUSTRIAL BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1620
Mailing Address - Country:US
Mailing Address - Phone:610-644-6251
Mailing Address - Fax:610-644-1440
Practice Address - Street 1:11 INDUSTRIAL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-644-6251
Practice Address - Fax:610-644-1440
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022547E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA198998Medicare ID - Type Unspecified
PAC33367Medicare UPIN