Provider Demographics
NPI:1568218626
Name:MARTIN, GRAHAM DELANO (PA-S)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:DELANO
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8201 HEALTHCARE LOOP STE 305
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7072
Practice Address - Country:US
Practice Address - Phone:980-302-3050
Practice Address - Fax:980-302-3055
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-15071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant