Healthcare Provider Details

I. General information

NPI: 1659497667
Provider Name (Legal Business Name): MICHAEL JOHN GRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CATHEDRAL AVE NW #114W
WASHINGTON DC
20016-4901
US

IV. Provider business mailing address

4201 CATHEDRAL AVE NW SUITE 114WEST
WASHINGTON DC
20016-4901
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-0813
  • Fax: 202-222-0429
Mailing address:
  • Phone: 202-686-0813
  • Fax: 202-222-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD15901
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15901
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: