Basic Information
| Provider Information | |||||||||
| NPI: | 1851355325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | SAM | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 MEDICAL CENTER CIR STE 208 | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229392273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403325926 | ||||||||
| FaxNumber: | 5403325930 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MEDICAL CENTER CIR STE 208 | ||||||||
| Address2: | |||||||||
| City: | FISHERSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403325926 | ||||||||
| FaxNumber: | 5403325930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 11/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101 057504 | VA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 21939 | 01 | VA | CIGNA | OTHER | 247998 | 01 | VA | ANTHEM BCBS 111506 | OTHER | 007502141 | 05 | VA | MEDICAID | 587608554 | 01 | VA | TRICARE | OTHER | 092640000-00 | 01 | VA | QUALCHOICE | OTHER | 4502225 | 01 | VA | AETNA PPO | OTHER | 9590 | 01 | VA | CARENET | OTHER | 3762531 | 01 | VA | AETNA HMO | OTHER | 1900016 | 01 | VA | UNITED HEALTHCARE | OTHER | 66232 | 01 | VA | CARENET EFF 111506 | OTHER | 1851355325 | 05 | VA | MEDICAID | 258638 | 01 | VA | ALLIANCE | OTHER | 45723 | 01 | VA | SENTARA FAMILY CARE | OTHER | 82978 | 01 | VA | SOUTHERN HEALTH | OTHER |