Provider Demographics
NPI:1730525577
Name:GRAHAM, KATHRYN GRAVES (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GRAVES
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MIDWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3857
Mailing Address - Country:US
Mailing Address - Phone:814-371-2348
Mailing Address - Fax:
Practice Address - Street 1:135 MIDWAY DR STE B
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3857
Practice Address - Country:US
Practice Address - Phone:814-371-2348
Practice Address - Fax:814-372-6089
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019426207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program