MEDICARE: DR. TIFANI GRIZZELL M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	D0063512	MD

General Provider Information

NPI Number	:	1740273564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFANI GRIZZELL M. D.

Provider Business Mailing Address
First Line	:	10505 LORAIN AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-2413
Country	:	US
Telephone Number	:	301-681-3007
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 WARRINGTON AVE SE
Second Line	:	BLD 183
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5022
Country	:	US
Telephone Number	:	202-433-3758
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/20/2015

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