Individual
LISA GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
101 DUDLEY ST, PROVIDENCE, RI 02905-2401
(401) 274-1122
Mailing address
101 DUDLEY ST, PROVIDENCE, RI 02905-2499
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
274281
MA
208000000X
Pediatrics Physician
Primary
DO00945
RI
Other
Enumeration date
03/25/2015
Last updated
11/13/2019
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