Healthcare Provider Details

I. General information

NPI: 1154236511
Provider Name (Legal Business Name): GRACEWAY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 DUAL HWY
HAGERSTOWN MD
21740-5909
US

IV. Provider business mailing address

10259 CABERY RD
ELLICOTT CITY MD
21042-1605
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-4020
  • Fax:
Mailing address:
  • Phone: 410-870-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRYSTLE D BROWN
Title or Position: BILLING MANAGER
Credential:
Phone: 410-870-9380