Provider Demographics
NPI:1235564907
Name:GRIFFIN, STEPHEN ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:ANTHONY
Other - Last Name:GRIFFIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 WHORL CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1757
Mailing Address - Country:US
Mailing Address - Phone:443-386-5715
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-787-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical