Healthcare Provider Details

I. General information

NPI: 1467087650
Provider Name (Legal Business Name): GILDA-RAE GRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 422 POB SOUTH TOWER
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

106 IRVING ST NW STE 422 POB SOUTH TOWER
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-0698
  • Fax: 202-877-6959
Mailing address:
  • Phone: 202-877-0698
  • Fax: 202-877-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0104008
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32701201
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD600003902
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: