Provider Demographics
NPI:1588664700
Name:GRILL, HOWARD PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:PHILIP
Last Name:GRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 NORTHUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1129
Mailing Address - Country:US
Mailing Address - Phone:124-721-3539
Mailing Address - Fax:
Practice Address - Street 1:1775 THOMPSON RD BAY AREA
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2125
Practice Address - Country:US
Practice Address - Phone:541-269-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045337E207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012237620013Medicaid
PA0012237620013Medicaid
PA601511Medicare PIN
PA601511PV1Medicare PIN
PA0012237620010Medicaid
PA0012237620002Medicaid
OH0134492Medicaid
PA0012237620008Medicaid
PA0012237620009Medicaid
PA0012237620013Medicaid
OH060063471Medicare PIN
PA0012237620005Medicaid
PA0012237620007Medicaid
PA0012237620003Medicaid
PA060062900Medicare PIN