Healthcare Provider Details

I. General information

NPI: 1477810208
Provider Name (Legal Business Name): GRACE MILAD FELIX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER CT
FAIRFAX VA
22031-2207
US

IV. Provider business mailing address

1518 PARK AVE APT 402N
BALTIMORE MD
21217-4772
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-2788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101264182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: