Individual
DR. LESLIE E. GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 ROCKLAND RD, WILMINGTON, DE 19803-3607
(302) 651-4000
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
C10002480
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1165522
—
LA
05
—
1197564
—
PA
05
—
1437681
—
NY
05
—
510123
—
IA
05
—
5166608
—
NJ
05
—
64195951
—
KY
05
—
7709013
—
MD
05
—
806321200
—
ID
05
—
XPY196074
—
CA
Enumeration date
09/29/2006
Last updated
02/04/2013
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