MEDICARE: DR. GRACE FAITH UMBALIN SALACUP MD

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	207RP1001X	Pulmonary Disease Physician	D0102250	MD
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	D0102250	MD

General Provider Information

NPI Number	:	1609438704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE FAITH UMBALIN SALACUP MD

Provider Business Mailing Address
First Line	:	100 E CARROLL ST
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5422
Country	:	US
Telephone Number	:	410-543-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E CARROLL ST
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5422
Country	:	US
Telephone Number	:	410-543-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	05/28/2026

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