Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 36003331G | OH |
NPI | 1336142561 |
---|---|
Provider Name | Ms. Mary Margaret Graham |
First Address | Chillicothe, OH 45601-1457 |
Second Address | Chillicothe, OH 45601-1174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2413721 | (05) | OH |
U95288 | (02) | OH |