Healthcare Provider Details

I. General information

NPI: 1295312700
Provider Name (Legal Business Name): GRACE ELIZABETH CINDERELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/10/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE
FREDERICK MD
21702-4747
US

IV. Provider business mailing address

1475 TANEY AVE
FREDERICK MD
21702-4747
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-0133
  • Fax: 301-695-8604
Mailing address:
  • Phone: 301-662-0133
  • Fax: 301-695-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0100768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: