Provider Demographics
NPI:1629127774
Name:GRAHAM, TERRI MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:MARIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERRI
Other - Middle Name:GRAHAM
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-368-6080
Mailing Address - Fax:206-368-6088
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-368-6080
Practice Address - Fax:206-368-6088
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030161208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154171Medicaid
WAF75309Medicare UPIN