Provider Demographics
NPI:1134117427
Name:GRIFFIN, MARY T (MSN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:TIMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:508-543-6371
Mailing Address - Fax:508-543-3347
Practice Address - Street 1:70 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-5312
Practice Address - Country:US
Practice Address - Phone:508-543-6371
Practice Address - Fax:508-543-3347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0326984Medicaid
MANP3120Medicare ID - Type Unspecified
MA0326984Medicaid