Provider Demographics
NPI:1689021123
Name:GRAHAM PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:GRAHAM PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-453-1036
Mailing Address - Street 1:6536 ANTHONY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1419
Mailing Address - Country:US
Mailing Address - Phone:585-300-4575
Mailing Address - Fax:
Practice Address - Street 1:6536 ANTHONY DR
Practice Address - Street 2:SUITE C
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1419
Practice Address - Country:US
Practice Address - Phone:585-300-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-14
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269255208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty