Healthcare Provider Details

I. General information

NPI: 1508519604
Provider Name (Legal Business Name): GRMC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N 4TH ST
OAKLAND MD
21550-1375
US

IV. Provider business mailing address

251 N 4TH ST
OAKLAND MD
21550-1375
US

V. Phone/Fax

Practice location:
  • Phone: 301-553-4000
  • Fax:
Mailing address:
  • Phone: 301-553-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARK BOUCOT
Title or Position: PRESIDENT
Credential:
Phone: 301-553-4000