Provider Demographics
NPI:1568450294
Name:GRAHAM, BARRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:E
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 1:1340 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2132
Mailing Address - Country:US
Mailing Address - Phone:610-375-4241
Mailing Address - Fax:610-373-0373
Practice Address - Street 1:1340 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2132
Practice Address - Country:US
Practice Address - Phone:610-375-4241
Practice Address - Fax:610-373-0373
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013918E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist