Provider Demographics
NPI:1811953409
Name:HUCKELL, GRAHAM R (MD)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:R
Last Name:HUCKELL
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 1:700 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1536
Mailing Address - Country:US
Mailing Address - Phone:716-854-5700
Mailing Address - Fax:716-854-5800
Practice Address - Street 1:700 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1536
Practice Address - Country:US
Practice Address - Phone:716-854-5700
Practice Address - Fax:716-854-5800
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205157-1207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1691Medicare PIN
NYG05317Medicare UPIN