Provider Demographics
NPI:1952533531
Name:GRAHAM, JAMIE L (CPED)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 BRANDYWINE PKWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1471
Mailing Address - Country:US
Mailing Address - Phone:302-230-3062
Mailing Address - Fax:302-230-3045
Practice Address - Street 1:5321 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1471
Practice Address - Country:US
Practice Address - Phone:302-230-3062
Practice Address - Fax:302-230-3045
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED3080211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric