Healthcare Provider Details

I. General information

NPI: 1174577928
Provider Name (Legal Business Name): ALEX GRILLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CONGRESS ST
QUINCY MA
02169-0908
US

IV. Provider business mailing address

500 CONGRESS ST
QUINCY MA
02169-0908
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-1717
  • Fax:
Mailing address:
  • Phone: 617-774-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number214103
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: