Provider Demographics
NPI:1104805928
Name:GRAMLEY, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GRAMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 MEETING CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6631
Mailing Address - Country:US
Mailing Address - Phone:910-342-0096
Mailing Address - Fax:910-342-0097
Practice Address - Street 1:1912 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-342-0096
Practice Address - Fax:910-342-0097
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891162XMedicaid
NC2267178Medicare UPIN
NCG36241Medicare UPIN