1235254111 NPI number — GEORGE THOMAS GRACE, M.D., P.A.

Table of content: TARIQ ASADULLAH KHAN M.D. (NPI 1396804662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235254111 NPI number — GEORGE THOMAS GRACE, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE THOMAS GRACE, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235254111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 FREDERICK RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-744-0900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FREDERICK RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-0900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRACE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-744-0900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 383691600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH9600 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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