Individual
MS. CYNTHIA MAE WILSON GRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 SOUTH ST, SUITE 102, SOUTHBRIDGE, MA 01550-4051
(508) 764-3194
(508) 765-5458
Mailing address
100 SOUTH ST, SUITE 102, SOUTHBRIDGE, MA 01550-4051
(508) 764-3194
(508) 765-5458
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
152581
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220019
—
MA
Enumeration date
07/31/2006
Last updated
02/01/2012
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