Provider Demographics
NPI:1023129269
Name:GRILL, STEPHEN ELLIOT (MD PHD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ELLIOT
Last Name:GRILL
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:8180 LARK BROWN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075
Mailing Address - Country:US
Mailing Address - Phone:443-755-0030
Mailing Address - Fax:443-755-0031
Practice Address - Street 1:8180 LARK BROWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075
Practice Address - Country:US
Practice Address - Phone:443-755-0030
Practice Address - Fax:443-755-0031
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00416972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD359191300Medicaid
MD359191300Medicaid
F62497Medicare UPIN