Provider Demographics
NPI:1073526307
Name:GRIFFIN, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:GRIFFIN
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 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-878-3177
Mailing Address - Fax:207-878-2156
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9422
Practice Address - Country:US
Practice Address - Phone:207-283-7980
Practice Address - Fax:207-283-7793
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018265208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010475799OtherTAX ID
010475799OtherTAX ID
RI007058718Medicare PIN