Basic Information
| Provider Information | |||||||||
| NPI: | 1295799666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PRESTIGE PL STE 550 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453426115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377621310 | ||||||||
| FaxNumber: | 9375228068 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 SOUTHERN BLVD STE 2100 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374335330 | ||||||||
| FaxNumber: | 9372980287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35.066570 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | D0055971 | MD | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 287705 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 903A | 01 | MD | CAREFIRST MARYLAND | OTHER | 331950400 | 05 | MD | MEDICAID | DC8030 | 01 | MD | RAILROAD MEDICARE | OTHER | J848 | 01 | MD | CAREFIRST DC | OTHER | DE5302 | 01 | MD | RAILROAD MEDICARE | OTHER |