Provider Demographics
NPI:1649390048
Name:GRAHAM, FIONA (MD)
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 CENTRAL PARK W
Mailing Address - Street 2:16A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6547
Mailing Address - Country:US
Mailing Address - Phone:212-316-3211
Mailing Address - Fax:212-866-4673
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:16A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-316-3211
Practice Address - Fax:212-866-4673
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00118781Medicaid
NY356871Medicare ID - Type UnspecifiedMEDICARE
NY00118781Medicaid