1245626498 NPI number — GRACE CHO WESSLING MD

Table of content: GRACE CHO WESSLING MD (NPI 1245626498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245626498 NPI number — GRACE CHO WESSLING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESSLING
Provider First Name:
GRACE
Provider Middle Name:
CHO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHO
Provider Other First Name:
GRACE
Provider Other Middle Name:
EUNJI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245626498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 TWIN SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALETHORPE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21227-3553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-737-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 TWIN SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALETHORPE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-737-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: D85908 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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