Provider Demographics
NPI:1053606319
Name:PATRICIA GRAHAM, MD PC
Entity type:Organization
Organization Name:PATRICIA GRAHAM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-303-0120
Mailing Address - Street 1:106 STRAUBE CENTER BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1449
Mailing Address - Country:US
Mailing Address - Phone:609-303-0120
Mailing Address - Fax:609-303-0151
Practice Address - Street 1:106 STRAUBE CENTER BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1449
Practice Address - Country:US
Practice Address - Phone:609-303-0120
Practice Address - Fax:609-303-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35396Medicare UPIN