Individual
MR. MARVIN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Mailing address
6305 MAPLE TREE LN, EAST LYME, CT 06333-1693
(305) 778-9477
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
8114
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
8114
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669930178
—
CT
05
—
1669930178
—
RI
Enumeration date
03/05/2019
Last updated
12/21/2021
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