Provider Demographics
NPI:1629416011
Name:LINK, GRACE E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:E
Last Name:LINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:ELLEN
Other - Last Name:SMOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3540
Mailing Address - Country:US
Mailing Address - Phone:412-373-1600
Mailing Address - Fax:412-373-4197
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3540
Practice Address - Country:US
Practice Address - Phone:412-373-1626
Practice Address - Fax:412-373-4197
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056184363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13577361OtherCAQH
PA420729Medicare PIN