Individual
DR. LEROY GRAHAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15408 WARWICK BLVD, NEWPORT NEWS, VA 23608-1576
(757) 890-0012
(757) 890-0013
Mailing address
15408 WARWICK BLVD, NEWPORT NEWS, VA 23608-1576
(757) 890-0012
(757) 890-0013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101229881
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145933
BLUE CROSS BLUE SHIELD
VA
01
—
2126544
MDIPA
VA
01
—
76157
OPTIMA
VA
Enumeration date
08/19/2006
Last updated
12/14/2007
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