Provider Demographics
NPI:1699941997
Name:GRILLI, JENNIFER W (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:GRILLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:CHRISTIANA CARE CORPORATE FINANCE CENTER
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 FOULK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3155
Practice Address - Country:US
Practice Address - Phone:302-655-8868
Practice Address - Fax:302-655-3744
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0004077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC2-0009653OtherMEDICAL LICENSE