Provider Demographics
NPI:1669560553
Name:PRINCE-TORAIN, GRACE M (DPM)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:PRINCE-TORAIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 PINEY ORCHARD PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1508
Mailing Address - Country:US
Mailing Address - Phone:410-674-3707
Mailing Address - Fax:410-674-3708
Practice Address - Street 1:8379 PINEY ORCHARD PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1508
Practice Address - Country:US
Practice Address - Phone:410-674-3707
Practice Address - Fax:410-674-3708
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01416213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV05181Medicare UPIN
MD203P461GMedicare PIN