Healthcare Provider Details

I. General information

NPI: 1073996849
Provider Name (Legal Business Name): GRACE ESARE-NKRUMAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UPPER CHESAPEAKE DR
BEL AIR MD
21014-4324
US

IV. Provider business mailing address

2201 US 62
OIL CITY PA
16301-4117
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-4120
  • Fax:
Mailing address:
  • Phone: 646-954-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD477638
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0097279
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101264383
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: