Provider Demographics
NPI:1891056388
Name:GRAHAM, ROSHEL KATHRYN EGBERT (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROSHEL
Middle Name:KATHRYN EGBERT
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ROSHEL
Other - Middle Name:KATHRYN
Other - Last Name:EGBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15725 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2312
Mailing Address - Country:US
Mailing Address - Phone:562-947-7754
Mailing Address - Fax:562-902-9599
Practice Address - Street 1:15725 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2312
Practice Address - Country:US
Practice Address - Phone:562-947-7754
Practice Address - Fax:562-902-9599
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126823208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics