Individual
NATHANIEL LARS GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
116 INTERSTATE PKWY, SUITE 31, BRADFORD, PA 16701-1036
(814) 368-7125
(814) 368-9156
Mailing address
116 INTERSTATE PKWY, SUITE 31, BRADFORD, PA 16701-1036
(814) 368-7125
(814) 368-9156
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD033525E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011267590002
—
PA
Enumeration date
06/09/2005
Last updated
09/20/2011
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