Provider Demographics
NPI:1891821435
Name:GRAHAM, BARRY GERARD (PA-C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:GERARD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2934 N ELM ST
Practice Address - Street 2:STE B
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2986
Practice Address - Country:US
Practice Address - Phone:910-272-1175
Practice Address - Fax:910-272-1176
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762146CMedicare PIN
Q28903Medicare UPIN