Provider Demographics
NPI:1740273564
Name:GRIZZELL, TIFANI (M D)
Entity type:Individual
Prefix:DR
First Name:TIFANI
Middle Name:
Last Name:GRIZZELL
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2413
Mailing Address - Country:US
Mailing Address - Phone:301-681-3007
Mailing Address - Fax:
Practice Address - Street 1:624 WARRINGTON AVE SE
Practice Address - Street 2:BLD 183
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5022
Practice Address - Country:US
Practice Address - Phone:202-433-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063512208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice