Healthcare Provider Details

I. General information

NPI: 1609859479
Provider Name (Legal Business Name): IULIA C. GRILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST DEPARTMENT OF INTERNAL MEDICINE
PAWTUCKET RI
02860-4400
US

IV. Provider business mailing address

111 BREWSTER ST DEPARTMENT OF INTERNAL MEDICINE
PAWTUCKET RI
02860-4400
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2258
  • Fax: 401-729-3343
Mailing address:
  • Phone: 401-729-2258
  • Fax: 401-729-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11388
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD11388
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: