Provider Demographics
NPI:1174755961
Name:GRAHAM, KRAIG S (MD)
Entity type:Individual
Prefix:
First Name:KRAIG
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7007 HARBOUR VIEW BLVD 108
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3657
Mailing Address - Country:US
Mailing Address - Phone:757-215-2784
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:5838 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-673-5680
Practice Address - Fax:757-483-3075
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2015-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101259090207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10932Medicare UPIN