Provider Demographics
NPI:1962013425
Name:SERAFINI, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SERAFINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 TUNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3422
Mailing Address - Country:US
Mailing Address - Phone:443-604-9374
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-5824
Practice Address - Country:US
Practice Address - Phone:410-427-3900
Practice Address - Fax:410-938-8461
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR086728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health