Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01078262A | IN |
N | 111NI0900X | Internist | 01078262A | IN |
Y | 207RC0200X | Critical Care Medicine | 01078262A | IN |
NPI | 1063808905 |
---|---|
Provider Name | Graham D Dellinger |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Avon, IN 46123-7085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201300880 | (05) | IN |