Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | D0041697 | MD |
NPI | 1023129269 |
---|---|
Provider Name | Mr. Stephen Elliot Grill |
First Address | Elkridge, MD 21075 |
Second Address | Elkridge, MD 21075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
359191300 | (05) | MD |
F62497 | (02) |