Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 22080 | SC |
Y | 2080P0203X | Pediatric Critical Care Doctor | 22080 | SC |
NPI | 1124136098 |
---|---|
Provider Name | Eric Matthew Graham |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
220807 | (05) | SC |
I31099 | (02) |