Provider Demographics
NPI:1811982838
Name:GRAHAM, BRUCE W (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5969 E BROAD ST
Mailing Address - Street 2:STE 202
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-863-1692
Mailing Address - Fax:614-575-5382
Practice Address - Street 1:477 COOPER RD
Practice Address - Street 2:STE 400
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8053
Practice Address - Country:US
Practice Address - Phone:614-865-4050
Practice Address - Fax:614-575-5382
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35045972G207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31418Medicare UPIN
GR0499581Medicare ID - Type Unspecified