Provider Demographics
NPI:1063647790
Name:GRIESHABER, PHILIP ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ARTHUR
Last Name:GRIESHABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3211
Mailing Address - Country:US
Mailing Address - Phone:610-253-2500
Mailing Address - Fax:
Practice Address - Street 1:241 N 13TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-253-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447515208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD447515OtherMEDICAL LICENSE NUMBER
FG7538258OtherDEA
PAMD447515OtherMEDICAL LICENSE NUMBER