Individual
GRACE PUTHENPURACKAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN, CDE
Contact information
Practice address
3993 TRACE HOLLOW RUN, SALISBURY, MD 21804-2552
(410) 548-1860
(410) 341-4629
Mailing address
3993 TRACE HOLLOW RUN, SALISBURY, MD 21804-2552
(410) 548-1860
(410) 341-4629
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DO1175
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022022
PRIORITYPARTNERS.JHHC
MD
01
—
0956915
AETNA HMO
MD
01
—
09DI
CAREFIRSTBCBS,PPO,POS
MD
01
—
216451
ALLIANCE.MAMSI.MDIPA.OC
MD
05
—
228231300
—
MD
01
—
238074
AMERIHEALTH
MD
01
—
328392
PRIMEHEALTH
MD
01
—
5640256
AETNA,PPO,POS
MD
01
—
6300008
UNITED HEALTH CARE
MD
01
—
7758298
CIGNA
MD
01
—
S2360001
BLUECHOICE,CAREFIRST
MD
01
—
V00003940
AMERICHOICEMA
MD
Enumeration date
12/04/2006
Last updated
07/09/2007
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