Basic Information
Provider Information
NPI: 1881763357
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAHAM
FirstName: JAMES
MiddleName: A.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEDICAL CENTER DR
Address2: DHMC - DEPT OF RADIOLOGY
City: LEBANON
State: NH
PostalCode: 037561000
CountryCode: US
TelephoneNumber: 6036505000
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER DR
Address2: DHMC - DEPT OF RADIOLOGY
City: LEBANON
State: NH
PostalCode: 037561000
CountryCode: US
TelephoneNumber: 6036507443
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/07/2006
LastUpdateDate: 06/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X0101249657VAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X14919NHY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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