# GRADY ENDOCRINOLOGY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548668452
- **Authorized official:** DR. JUSTIN GRADY MATRISCIANO M.D. (MANAGING MEMBER / OWNER)
- **Authorized official phone:** (516) 380-1490

## Contact information

- **Practice address:** 10512 S GLENSTONE PL, SUITE 102, BATON ROUGE, LA 70810-2966
- **Practice address phone:** (225) 505-5532
- **Practice address fax:** (225) 926-9674
- **Mailing address:** 10512 S GLENSTONE PL, SUITE 102, BATON ROUGE, LA 70810-2966
- **Mailing address phone:** (225) 505-5532
- **Mailing address fax:** (225) 926-9674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | MD202783 | LA | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014