Provider Demographics
NPI:1629299342
Name:ANTHONY W. GRAHAM, M.D., P.L.L.C..
Entity Type:Organization
Organization Name:ANTHONY W. GRAHAM, M.D., P.L.L.C..
Other - Org Name:FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-727-6270
Mailing Address - Street 1:509 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2824
Mailing Address - Country:US
Mailing Address - Phone:304-727-6270
Mailing Address - Fax:304-727-6271
Practice Address - Street 1:509 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2824
Practice Address - Country:US
Practice Address - Phone:304-727-6270
Practice Address - Fax:304-727-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9330131Medicare PIN
WVA71923Medicare UPIN