Provider Demographics
NPI:1962437178
Name:GRAHAM, JULIANNE P (PA)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:P
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845398
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-5398
Mailing Address - Country:US
Mailing Address - Phone:888-447-2450
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0485363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00355263OtherRAILROAD MEDICARE
NH30332485Medicaid
NHP01146908OtherRAILROAD MCARE
NHAP2020Medicare PIN
AP202003Medicare PIN
P00355263OtherRAILROAD MEDICARE
NHAP202001Medicare PIN