Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 214103 | MA |
NPI | 1174577928 |
---|---|
Provider Name | Alex Grilli |
First Address | Quincy, MA 02169-0908 |
Second Address | Quincy, MA 02169-0908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 12/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0198731 | (05) | MA |
H65439 | (02) | MA |