Provider Demographics
NPI:1053924522
Name:ANDERSON, GRAHAM JOSHUA (CRPA-P4479)
Entity type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:JOSHUA
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CRPA-P4479
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LINWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209
Mailing Address - Country:US
Mailing Address - Phone:716-424-4211
Mailing Address - Fax:716-884-4211
Practice Address - Street 1:64 LINWOOD AVE.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-424-4211
Practice Address - Fax:716-884-4211
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-P-4470175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist