Provider Demographics
NPI:1720439920
Name:GRAHAM, ELEANOR S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:S
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 1:4137 HUNTERS PARK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7669
Mailing Address - Country:US
Mailing Address - Phone:407-304-1790
Mailing Address - Fax:407-304-1706
Practice Address - Street 1:4137 HUNTERS PARK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7669
Practice Address - Country:US
Practice Address - Phone:407-304-1790
Practice Address - Fax:407-304-1706
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139812208000000X
FLTRN23478390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program