Healthcare Provider Details

I. General information

NPI: 1275501959
Provider Name (Legal Business Name): GRACE F. KAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W REDWOOD ST. 6TH FLOOR
BALTIMORE MD
21201-7005
US

IV. Provider business mailing address

PO BOX 64445
BALTIMORE MD
21264-4445
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5766
  • Fax: 410-328-0098
Mailing address:
  • Phone: 410-328-5766
  • Fax: 410-328-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD3852
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0017574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: