Provider Demographics
NPI:1114173846
Name:GRAHAM, TAMARA NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NICOLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:112 GAINSBOROUGH SQ STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1706
Practice Address - Country:US
Practice Address - Phone:757-410-2287
Practice Address - Fax:757-410-7747
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2024-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant