Provider Demographics
NPI:1285718742
Name:GRAHAM, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:VIVACQUA PAVILION, SUITE 233
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-499-0400
Mailing Address - Fax:610-499-1970
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:VIVACQUA PAVILION, SUITE 233
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-499-0400
Practice Address - Fax:610-499-1970
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA058253002086S0129X
PAMD4523782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5211409Medicaid
NJ080289BT5Medicare PIN
NJF36210Medicare UPIN