Healthcare Provider Details

I. General information

NPI: 1487609418
Provider Name (Legal Business Name): GRACE KOBUSINGYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ROCK SPRING RD SUITE # ONE
FOREST HILL MD
21050-2621
US

IV. Provider business mailing address

2005 ROCK SPRING RD SUITE # ONE
FOREST HILL MD
21050-2621
US

V. Phone/Fax

Practice location:
  • Phone: 410-420-1743
  • Fax: 410-420-3520
Mailing address:
  • Phone: 410-420-1743
  • Fax: 410-420-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0045867
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: