Provider Demographics
NPI:1043473739
Name:WARREN, GRAHAM WALTER (MD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:WALTER
Last Name:WARREN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST STE C114D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8908
Practice Address - Country:US
Practice Address - Phone:859-257-7618
Practice Address - Fax:859-257-4060
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC352822085R0001X
NY2538832085R0203X
KY604542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03122896Medicaid
NYJ400004935Medicare PIN