1386848034 NPI number — GEORGE T. GRACE, M.D. SURGERY CENTER

Table of content: (NPI 1386848034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386848034 NPI number — GEORGE T. GRACE, M.D. SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE T. GRACE, M.D. SURGERY CENTER
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:
1386848034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRACE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-744-0900

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1300 , 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)

  • Identifier: 841431 01 . This is a "BC BS NATIONAL ACCOUNTS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 283469 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 026O . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2188425 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 58910 . This is a "JOHNS HOPKINS HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7594024 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RW2 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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