MEDICARE: MARY B GRACEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	AT000770L	PA

General Provider Information

NPI Number	:	1508367913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY B GRACEY LLC

Provider Business Mailing Address
First Line	:	3542 WHITE OAK CT
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-3481
Country	:	US
Telephone Number	:	215-343-5568
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 COWPATH RD STE 2
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-1152
Country	:	US
Telephone Number	:	215-362-6700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY B GRACEY
Credential	:	M.A.
Telephone Number	:	215-343-5568

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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