NPIMap

Organization Active NPI

Graceway Health Care LLC

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1346061124
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GRACEWAY HEALTH CARE LLC
Practice address
115 E Melrose Ave
Baltimore, MD 21212-2945
Phone
(410) 435-9073
NPI assigned
Oct 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Krystle D Brown
Title
Billing Manager
Phone
(410) 870-9380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

115 E Melrose Ave
Baltimore, MD 21212-2945

Mailing address

10259 Cabery Rd
Ellicott City, MD 21042-1605
Phone (410) 870-9380

Other names 1

  • GRACEWAY HEALTH CARE AL LONG GREEN Other name

National Provider Directory

National Provider Directory
Tax ID family
Graceway Health Care LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1346061124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10259 CABERY RD",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210421605",
            "telephone_number": "410-870-9380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E MELROSE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212122945",
            "telephone_number": "410-435-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWAY HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "410-870-9380"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRACEWAY HEALTH CARE AL LONG GREEN",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GRACEWAY HEALTH CARE AL LONG GREEN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.