Individual
POWELL L. GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 421-1400
(508) 421-1490
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
282290
MA
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
282290
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110124642A
—
MA
Enumeration date
03/28/2017
Last updated
06/15/2022
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