Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 214275 | NY |
Y | 2080P0208X | Pediatric Infectious Diseases | 214275 | NY |
NPI | 1093781478 |
---|---|
Provider Name | Dr. Philip L Graham III |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 22/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02166585 | (05) | NY |
I30164 | (02) | NY |