Provider Demographics
NPI:1972577716
Name:CARRILLO, ADRIANA G (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:G
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADRIANA
Other - Middle Name:G
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:G1
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-2300
Mailing Address - Fax:617-698-7542
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:G1
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-2300
Practice Address - Fax:617-698-7542
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209121207X00000X, 2081S0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0186571Medicaid
MA0186571Medicaid