Provider Demographics
NPI:1124225206
Name:GRIFFIN, SUSANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:GRIFFIN
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 1:100 MCGREGOR ST
Mailing Address - Street 2:EMERG DEPT
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:606-663-6478
Mailing Address - Fax:603-663-6645
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:EMERG DEPT
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:606-663-6478
Practice Address - Fax:603-663-6645
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232584207P00000X
NH14870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA183520OtherHPHC
NH30209646Medicaid
NHP00858529OtherRAILROAD MEDICARE
NH1124225206OtherANTHEM BC BS NH
NHP00858529OtherRAILROAD MEDICARE