| Graceway Health Care Llc | |
|
10259 Cabery Rd Ellicott City MD 21042-1605 | |
| (667) 300-8222 | |
| Not Available |
| Full Name | Graceway Health Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10259 Cabery Rd, Ellicott City, Maryland |
| Authorized Official Name and Position | Krystle Brown (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 4108006251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Graceway Health Care Llc 10259 Cabery Rd Ellicott City MD 21042-1605 Ph: (667) 300-8222 | Graceway Health Care Llc 10259 Cabery Rd Ellicott City MD 21042-1605 Ph: (667) 300-8222 |
| NPI Number | 1013669084 |
|---|---|
| Provider Enumeration Date | 01/21/2022 |
| Last Update Date | 06/07/2023 |
| Medicare PECOS PAC ID | 9537544648 |
|---|---|
| Medicare Enrollment ID | O20220909001488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013669084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ali M Yahya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013934181 PECOS PAC ID: 8022141803 Enrollment ID: I20100730000183 |
| Provider Name | Addisu M Temesgen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386971927 PECOS PAC ID: 4183812266 Enrollment ID: I20101216000820 |
| Provider Name | Benorayehush B Weldetsadik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255579744 PECOS PAC ID: 6507049814 Enrollment ID: I20120110000377 |
| Provider Name | Sharen Ayensu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952642357 PECOS PAC ID: 4789963547 Enrollment ID: I20161229001932 |
| Provider Name | Mesay W Gebresilassie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568918472 PECOS PAC ID: 9537448741 Enrollment ID: I20171012000248 |
| Provider Name | Yolanda Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073846382 PECOS PAC ID: 3274898861 Enrollment ID: I20180601000328 |
| Provider Name | Morenike E Agboola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811469414 PECOS PAC ID: 0244667343 Enrollment ID: I20200303000015 |
| Provider Name | Lilian Osei |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568007862 PECOS PAC ID: 7719315241 Enrollment ID: I20200318000136 |
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