Provider Demographics
NPI:1700178209
Name:WATSON, GRAHAM THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:THOMAS
Last Name:WATSON
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 1:5900 LAKE WRIGHT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0026
Mailing Address - Country:US
Mailing Address - Phone:757-213-5683
Mailing Address - Fax:757-213-5762
Practice Address - Street 1:1051 LOFTIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3069
Practice Address - Country:US
Practice Address - Phone:757-873-9400
Practice Address - Fax:757-983-9420
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50611207R00000X
VA0101262577207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008236Medicaid
TN103I110955Medicare PIN