Provider Demographics
NPI:1447678610
Name:GRISOLI, STRATTON (MD)
Entity type:Individual
Prefix:
First Name:STRATTON
Middle Name:
Last Name:GRISOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7512
Mailing Address - Country:US
Mailing Address - Phone:985-892-3376
Mailing Address - Fax:985-892-2055
Practice Address - Street 1:150 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7512
Practice Address - Country:US
Practice Address - Phone:985-892-3376
Practice Address - Fax:985-892-2055
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.208001207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program