Individual
DR. LENORE MARIE TIETJENS-GRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9001 EDMONSTON RD STE 40, GREENBELT, MD 20770-1004
(240) 790-3325
(301) 345-1865
Mailing address
110 MISTY LN, ELKTON, MD 21921-2314
(443) 553-0631
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
C1-0004254
DE
207VG0400X
Gynecology Physician
Primary
D0046167
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162081900
—
MD
Enumeration date
12/28/2006
Last updated
02/06/2019
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