Healthcare Provider Details

I. General information

NPI: 1023070414
Provider Name (Legal Business Name): CANDICE D GRACE-LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR SUITES 102/103
BALTIMORE MD
21237-3930
US

IV. Provider business mailing address

9105 FRANKLIN SQUARE DR SUITES 102/103
BALTIMORE MD
21237-3930
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7878
  • Fax:
Mailing address:
  • Phone: 443-777-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0034640
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: