=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164640355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACEMPRINCETORAIN DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8379 PINEY ORCHARD PKWY D
-----------------------------------------------------
City | ODENTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21113-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-674-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8379 PINEY ORCHARD PKWY D
-----------------------------------------------------
City | ODENTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21113-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-674-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. GRACE M PRINCE-TORAIN
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 410-674-3707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 01416
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------