Provider Demographics
NPI:1689621203
Name:FRANK & GRACE, INC.
Entity Type:Organization
Organization Name:FRANK & GRACE, INC.
Other - Org Name:SISOM OSIA, M.D./ GATEWAY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SISOM
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-599-7010
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-2070
Mailing Address - Country:US
Mailing Address - Phone:301-599-7010
Mailing Address - Fax:301-599-1222
Practice Address - Street 1:9628 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:301-599-7010
Practice Address - Fax:301-599-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051701101Medicaid
G00707Medicare ID - Type Unspecified
H07083Medicare UPIN