Marlon Anthony Graham, MD | |
512 Village Rd Ste 104, Shallotte, NC 28470-3409 | |
(910) 721-4200 | |
(910) 754-3811 |
Full Name | Marlon Anthony Graham |
---|---|
Gender | Male |
Speciality | Psychiatry |
Experience | 42 Years |
Location | 512 Village Rd Ste 104, Shallotte, North Carolina |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1518921642 | NPI | - | NPPES |
179154 | Other | VA | ANTHEM |
179156 | Other | VA | ANTHEM |
178300 | Other | VA | ANTHEM |
01455137 | Other | VA | AMERIGROUP |
552451 | Other | VA | VALUE OPTIONS |
004945298 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 0101039537 (Virginia) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 2024-02500 (North Carolina) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
New River Valley Community Services | 3173518230 | 33 |
Entity Name | New River Valley Community Services |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1942304126 PECOS PAC ID: 3173518230 Enrollment ID: O20040417000460 |
Entity Name | Blue Ridge Medical Management Corporation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1326159567 PECOS PAC ID: 9739099441 Enrollment ID: O20040715001336 |
Entity Name | Mount Rogers Community Services |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1255365599 PECOS PAC ID: 1254387475 Enrollment ID: O20050510001179 |
Mailing Address | Practice Location Address |
---|---|
Marlon Anthony Graham, MD Po Box 60447, Charlotte, NC 28260-0447 Ph: () - | Marlon Anthony Graham, MD 512 Village Rd Ste 104, Shallotte, NC 28470-3409 Ph: (910) 721-4200 |
Borislav Margaritov Mravkov, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 204 Smith Ave, Shallotte, NC 28470 Phone: 910-721-4220 Fax: 910-721-4229 | |
Dr. David A. Joseph, M.D. Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 4647 Main St, Ste. 5, Shallotte, NC 28470 Phone: 910-755-6606 Fax: 910-755-6608 | |
Dr. Robert M. Licata, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 120 Coastal Horizons Dr, Shallotte, NC 28470 Phone: 910-754-4515 |