Provider Demographics
NPI:1932592417
Name:GRAHAM, MARIE ELISE ROEBUCK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE ELISE
Middle Name:ROEBUCK
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 1:800 COMMISSIONERS ROAD E, BOX 5010
Mailing Address - Street 2:CHILDREN'S HOSPITAL, LONDON HEALTH SCIENCES CENTRE
Mailing Address - City:LONDON
Mailing Address - State:ON
Mailing Address - Zip Code:N6A 5W9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 COMMISSIONERS ROAD E
Practice Address - Street 2:CHILDREN'S HOSPITAL, LONDON HEALTH SCIENCES CENTRE
Practice Address - City:LONDON
Practice Address - State:ON
Practice Address - Zip Code:N6A 5W9
Practice Address - Country:CA
Practice Address - Phone:902-473-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ015863207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology