Provider Demographics
NPI:1609961382
Name:PURCELL, GRAHAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:A
Last Name:PURCELL
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 1:17525 VENTURA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3843
Mailing Address - Country:US
Mailing Address - Phone:818-986-0200
Mailing Address - Fax:818-933-8961
Practice Address - Street 1:17525 VENTURA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3843
Practice Address - Country:US
Practice Address - Phone:818-986-0200
Practice Address - Fax:818-933-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30741207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30741OtherSTATE LICENSE
CAA26212Medicare UPIN