Provider Demographics
NPI:1043262637
Name:GRIFF, CHARLES E (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:GRIFF
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5815
Mailing Address - Country:US
Mailing Address - Phone:561-357-5636
Mailing Address - Fax:561-357-7452
Practice Address - Street 1:3400 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5815
Practice Address - Country:US
Practice Address - Phone:561-357-5636
Practice Address - Fax:561-357-7452
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG26680Medicare UPIN
FLK5722Medicare ID - Type Unspecified