Provider Demographics
NPI:1487759643
Name:MBONDE, GRACE E (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:E
Last Name:MBONDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-812-3950
Practice Address - Street 1:2250 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2857
Practice Address - Country:US
Practice Address - Phone:717-851-1566
Practice Address - Fax:717-812-3950
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0808207Q00000X
PAMD446199207Q00000X
MDD0075330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA418793OtherUPMC
PA30133660OtherAMERIHEALTH MERCY - CE
PA102744032Medicaid
PA1612005OtherGATEWAY
PA30133661OtherAMERIHEALTH MERCY - WRC
PA2719987OtherHIGHMARK BLUE SHIELD
NM59836733Medicaid
NM59836733Medicaid
MD245269FLTMedicare PIN
PA2719987OtherHIGHMARK BLUE SHIELD
PA30133661OtherAMERIHEALTH MERCY - WRC