MEDICARE: GRACE HUGHES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	091223	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	091223	OTHER	NY	SPECIALTY NUMBER 069

General Provider Information

NPI Number	:	1104056811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE HUGHES M.D.

Provider Business Mailing Address
First Line	:	160 COLUMBIA HTS
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2170
Country	:	US
Telephone Number	:	718-237-0731
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 COLUMBIA HTS
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2170
Country	:	US
Telephone Number	:	718-237-0731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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