Provider Demographics
NPI:1205856846
Name:GRADY, MARY KAY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:GRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 GEORGIA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1925
Mailing Address - Country:US
Mailing Address - Phone:301-946-5100
Mailing Address - Fax:301-929-0348
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:301-946-5100
Practice Address - Fax:301-929-0348
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21277207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02392065Medicaid
DC501322OtherNCPPO
DC5713051OtherAETNA NON HMO
DC0068OtherCAREFIRST BCBS
VA441030OtherANTHEM BCBS
DC5261462OtherCCN
DC2607621OtherAETNA HMO
DC102674OtherKAISER
VA5704855Medicaid
DC3937773002OtherCIGNA HMO
DC3937773002OtherCIGNA HMO
DCG14479Medicare UPIN