Provider Demographics
NPI:1457320814
Name:GRACE, DAVID MARK (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:GRACE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:UNIT 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8678
Practice Address - Country:US
Practice Address - Phone:301-698-9260
Practice Address - Fax:301-698-8962
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD01249213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6359 0001OtherBLUE CHOICE
MD480030745OtherMEDICARE RAILROAD
MD431710600Medicaid
MD54664503OtherBLUE CROSS
MD337615YFCHMedicare PIN
U66823Medicare UPIN
MD54664503OtherBLUE CROSS
MD6359 0001OtherBLUE CHOICE
MD431710601Medicaid