Individual
REGINALD EUGENE DEGRAFENREID JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.P., PMH-NP
Contact information
Practice address
1866 REISTERSTOWN RD, F, BALTIMORE, MD 21208-1335
(410) 484-5642
(410) 484-5541
Mailing address
1411 GLENDALE RD, BALTIMORE, MD 21239-1408
(410) 733-2544
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R193260
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R193260
MD
Other
Enumeration date
11/18/2015
Last updated
09/30/2019
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