Grady Endocrinology Center LLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

MD202783 Issued in LA

Legal business name

GRADY ENDOCRINOLOGY CENTER LLC

Practice address

10512 S Glenstone PL
Suite 102
Baton Rouge, LA 70810-2966

Phone

(225) 505-5532

Fax

(225) 926-9674

NPI assigned

Dec 9, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Justin Grady Matrisciano, M.D.

Title

Managing Member / Owner

Phone

(516) 380-1490

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1548668452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10512 S GLENSTONE PL",
            "address_2": "SUITE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708102966",
            "telephone_number": "225-505-5532",
            "fax_number": "225-926-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10512 S GLENSTONE PL",
            "address_2": "SUITE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708102966",
            "telephone_number": "225-505-5532",
            "fax_number": "225-926-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY ENDOCRINOLOGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "MATRISCIANO",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "GRADY",
        "authorized_official_title_or_position": "MANAGING MEMBER / OWNER",
        "authorized_official_telephone_number": "516-380-1490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "LA",
            "license": "MD202783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.