Healthcare Provider Details

I. General information

NPI: 1386402956
Provider Name (Legal Business Name): GRACE A COONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

513 HANNA RD
BEL AIR MD
21014-5375
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-6500
  • Fax:
Mailing address:
  • Phone: 443-903-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: