Provider Demographics
NPI:1013088830
Name:GRAHAM, VIRGIL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:LEE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7053
Mailing Address - Country:US
Mailing Address - Phone:301-221-3998
Mailing Address - Fax:301-618-5673
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:DEPT OF OBGYN
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5578
Practice Address - Fax:301-618-5673
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53099207V00000X
DCMD30787207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
012619K92Medicare ID - Type Unspecified
F55843Medicare UPIN