Provider Demographics
NPI:1306013214
Name:LOUIE, GRANT H (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:H
Last Name:LOUIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 UNIVERSITY BLVD W STE 310
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1990
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-3132
Practice Address - Street 1:2730 UNIVERSITY BLVD W STE 310
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1990
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-942-3132
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80795207RR0500X
MDD71182207RR0500X
MDD0071182207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036428200Medicaid
MD036428200Medicaid