Individual
MARLON ANTHONY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
512 VILLAGE RD STE 104, SHALLOTTE, NC 28470-3409
(910) 721-4200
(910) 754-3811
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101039537
VA
2084P0800X
Psychiatry Physician
Primary
2024-02500
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945298
—
VA
01
—
01455137
AMERIGROUP
VA
01
—
178300
ANTHEM
VA
01
—
179154
ANTHEM
VA
01
—
179156
ANTHEM
VA
01
—
552451
VALUE OPTIONS
VA
Enumeration date
04/14/2006
Last updated
09/05/2024
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