Provider Demographics
NPI:1851355325
Name:GRAHAM, SAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:70 MEDICAL CENTER CIR STE 208
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2273
Mailing Address - Country:US
Mailing Address - Phone:540-332-5926
Mailing Address - Fax:540-332-5930
Practice Address - Street 1:70 MEDICAL CENTER CIR STE 208
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-332-5926
Practice Address - Fax:540-332-5930
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 057504208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA21939OtherCIGNA
VA247998OtherANTHEM BCBS 111506
VA007502141Medicaid
VA587608554OtherTRICARE
VA092640000-00OtherQUALCHOICE
VA4502225OtherAETNA PPO
VA9590OtherCARENET
VA3762531OtherAETNA HMO
VA1900016OtherUNITED HEALTHCARE
VA66232OtherCARENET EFF 111506
VA1851355325Medicaid
VA258638OtherALLIANCE
VA45723OtherSENTARA FAMILY CARE
VA82978OtherSOUTHERN HEALTH
VAD45459Medicare UPIN
VAP00421898Medicare PIN
VA092640000-00OtherQUALCHOICE