Provider Demographics
NPI:1376508846
Name:GRACE, DANIEL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM
Last Name:GRACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-368-4570
Mailing Address - Fax:585-368-4575
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-368-4570
Practice Address - Fax:585-368-4575
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237828207VM0101X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02736107Medicaid
NYJ400003513-70008AMedicare PIN
NY02736107Medicaid
NYP020237828OtherBLUE SHIELD
NYRB0109Medicare ID - Type Unspecified
I07110Medicare UPIN
NYJ400003512-BA0017Medicare PIN
NY7362583OtherAETNA