Provider Demographics
NPI:1740276658
Name:GRILLO, JENNIFER A (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
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 1:41 MALL ROAD
Mailing Address - Street 2:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8630
Mailing Address - Fax:781-744-5581
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-722-7287
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212808204R00000X, 2084N0400X
NH116242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0027070OtherNHP
MA0171701Medicaid
MA212808OtherTHP
NH01Y004898MA01OtherANTHEM
MA05-00725OtherUHC
MA111344OtherHPHC
NH30203394Medicaid
MA55519OtherFCHP
MA05-00651OtherEVERCARE
MA2081539-001OtherCIGNA
MA7725353OtherAETNA
MAJ24976OtherBCBSMA
MA55519OtherFCHP
NH01Y004898MA01OtherANTHEM