# GRACE E MBONDE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1487759643
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D0075330 | MD | — |
| 207Q00000X | Family Medicine Physician | MD2008-0808 | NM | — |
| 207Q00000X | Family Medicine Physician | MD446199 | PA | Yes |

## Other

- **Enumeration date:** 09/13/2006
- **Last updated:** 06/19/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102744032 | — | PA |
| 01 | — | 1612005 | GATEWAY | PA |
| 01 | — | 2719987 | HIGHMARK BLUE SHIELD | PA |
| 01 | — | 30133660 | AMERIHEALTH MERCY - CE | PA |
| 01 | — | 30133661 | AMERIHEALTH MERCY - WRC | PA |
| 01 | — | 418793 | UPMC | PA |
| 05 | — | 59836733 | — | NM |