Provider Demographics
NPI:1144350653
Name:DALE, GRADY JR (EDD)
Entity type:Individual
Prefix:DR
First Name:GRADY
Middle Name:
Last Name:DALE
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 FALLS ROAD
Mailing Address - Street 2:FALLS LANE MEDICAL CENTER STE E
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1226
Mailing Address - Country:US
Mailing Address - Phone:410-578-0336
Mailing Address - Fax:410-361-0651
Practice Address - Street 1:4119 FALLS RD STE E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1642
Practice Address - Country:US
Practice Address - Phone:410-963-0085
Practice Address - Fax:410-366-1668
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty