Anisa Marie Graham, PHLEBOTOMIST/MA

Key facts

NPI

1699440313

Entity type

Individual (NPI type 1)

Primary specialty

Pathology Technician 246R00000X

Practice address

5091 Breezewood CT
Indian Head, MD 20640-3731

Phone

(301) 710-7674

Fax

(240) 903-2126

NPI assigned

Aug 13, 2021

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 13, 2021.

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1699440313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5091 BREEZEWOOD CT",
            "city": "INDIAN HEAD",
            "state": "MD",
            "postal_code": "206403731",
            "telephone_number": "301-710-7674",
            "fax_number": "240-903-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5091 BREEZEWOOD CT",
            "city": "INDIAN HEAD",
            "state": "MD",
            "postal_code": "206403731",
            "telephone_number": "301-710-7674",
            "fax_number": "240-903-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "ANISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PHLEBOTOMIST/MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246R00000X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Indian Head, MD · Pathology Technician in Maryland