Provider Demographics
NPI:1649408824
Name:GRIJALVA, GILLIAN BRESLIN (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:BRESLIN
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9746
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-5040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3218
Practice Address - Country:US
Practice Address - Phone:207-798-4050
Practice Address - Fax:207-798-4018
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA252563208000000X
NY276241208000000X
MEMD23707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics