Provider Demographics
NPI:1508819608
Name:GRILLO, JOSEPH FRANK (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANK
Last Name:GRILLO
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 1:594 GREAT RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6810
Mailing Address - Country:US
Mailing Address - Phone:401-768-3400
Mailing Address - Fax:401-768-3400
Practice Address - Street 1:594 GREAT RD STE 102A
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6810
Practice Address - Country:US
Practice Address - Phone:401-768-3400
Practice Address - Fax:401-768-3400
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH81059Medicare UPIN