Provider Demographics
NPI:1609859479
Name:GRILLO, IULIA C (MD)
Entity Type:Individual
Prefix:
First Name:IULIA
Middle Name:C
Last Name:GRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-2258
Mailing Address - Fax:401-729-3343
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2258
Practice Address - Fax:401-729-3343
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11388207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003519Medicaid
RI9003519Medicaid
RI007058096Medicare PIN