Basic Information
| Provider Information | |||||||||
| NPI: | 1013088830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | VIRGIL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 MALLARD CT | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207747053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012213998 | ||||||||
| FaxNumber: | 3016185673 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 MERCANTILE LN | ||||||||
| Address2: | DEPT OF OBGYN | ||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016185578 | ||||||||
| FaxNumber: | 3016185673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D53099 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | MD30787 | DC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.