Healthcare Provider Details

I. General information

NPI: 1487979720
Provider Name (Legal Business Name): TORIE GRANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

600 N WOLFE STREET CMCS 1102
BALTIMORE MD
21287-2128
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6662
  • Fax:
Mailing address:
  • Phone: 410-955-5883
  • Fax: 410-955-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD78295
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: