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NPI Code Detail

MEDICARE: GRACEWAY HEALTH CARE LLC

MEDICARE: GRACEWAY HEALTH CARE 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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1962329250
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACEWAY HEALTH CARE LLC
Provider Business Mailing Address
First Line : 10259 CABERY RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-1605
Country : US
Telephone Number : 410-870-9380
Fax Number :
Provider Business Practice Location Address
First Line : 1234 WASHINGTON RD
Second Line :
City : WESTMINSTER
State : MD
Zip : 21157-5854
Country : US
Telephone Number : 410-848-0700
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : KRYSTLE D BROWN
Credential :
Telephone Number : 410-870-9380
Provider Enumeration Date : 06/30/2026
Last Update Date : 06/30/2026

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Directions to “GRACEWAY HEALTH CARE LLC ” Practice Location

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