Provider Demographics
NPI:1386848034
Name:GEORGE T. GRACE, M.D. SURGERY CENTER
Entity Type:Organization
Organization Name:GEORGE T. GRACE, M.D. SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-744-0900
Mailing Address - Street 1:300 FREDERICK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4665
Mailing Address - Country:US
Mailing Address - Phone:410-744-0900
Mailing Address - Fax:
Practice Address - Street 1:300 FREDERICK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4665
Practice Address - Country:US
Practice Address - Phone:410-744-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1300261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD841431 01OtherBC BS NATIONAL ACCOUNTS
MD283469OtherMAMSI
MD026OOtherBLUE CROSS BLUE SHIELD
MD2188425OtherAETNA HMO
MD58910OtherJOHNS HOPKINS HEALTH PLAN
MD7594024OtherAETNA
MDRW2OtherFEDERAL BLUE CROSS
MD026OOtherBLUE CROSS BLUE SHIELD
MD109ZMedicare ID - Type Unspecified