Provider Demographics
NPI:1427350891
Name:GRAHAM, DARRON
Entity type:Individual
Prefix:
First Name:DARRON
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GRAND CONCOURSE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3106
Mailing Address - Country:US
Mailing Address - Phone:912-484-8655
Mailing Address - Fax:
Practice Address - Street 1:750 GRAND CONCOURSE
Practice Address - Street 2:APT 5B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3106
Practice Address - Country:US
Practice Address - Phone:912-484-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297810-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse