Healthcare Provider Details

I. General information

NPI: 1134395445
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH GRILLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN - STANTON ROAD SUITE 1E-20
NEWARK DE
19718
US

IV. Provider business mailing address

4755 OGLETOWN - STANTON ROAD SUITE 1E-20
NEWARK DE
19718
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5625
  • Fax: 302-733-5665
Mailing address:
  • Phone: 302-733-5625
  • Fax: 302-733-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC7-0004033
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS016894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: