Marvin Graham, CRNA
Nurse Anesthetist, Certified Registered in New London, CT. Individual provider (NPI-1).
NPI number1669930178
StatusActive
Last updated in NPPESDec 21, 2021
Details
- NPI
- 1669930178
- Entity type
- Individual (NPI-1)
- Name
- Mr. Marvin Graham
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 5, 2019
- Certification date
- Dec 21, 2021
- Last updated
- Dec 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 8114 | CT | Yes |
| 207L00000X | Anesthesiology | 8114 | CT |
Practice location
365 Montauk AveNew London, CT 06320-4700
Phone 860-442-0711
Mailing address
6305 Maple Tree LnEast Lyme, CT 06333-1693
Phone 305-778-9477
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