Provider Demographics
NPI:1508367913
Name:MARY B GRACEY LLC
Entity Type:Organization
Organization Name:MARY B GRACEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:215-343-5568
Mailing Address - Street 1:3542 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3481
Mailing Address - Country:US
Mailing Address - Phone:215-343-5568
Mailing Address - Fax:
Practice Address - Street 1:108 COWPATH RD STE 2
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1152
Practice Address - Country:US
Practice Address - Phone:215-362-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000770L261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech