Provider Demographics
NPI:1134234735
Name:GRILLO, TERESA MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIA
Last Name:GRILLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TERSEA
Other - Middle Name:MARIA
Other - Last Name:GRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:7410 WINDSTREAM CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-5060
Mailing Address - Country:US
Mailing Address - Phone:443-204-3939
Mailing Address - Fax:888-609-9664
Practice Address - Street 1:7410 WINDSTREAM CIR APT 301
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-5060
Practice Address - Country:US
Practice Address - Phone:443-204-3939
Practice Address - Fax:888-609-9664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1396152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64805Medicare UPIN
FLAF525Medicare PIN