Provider Demographics
NPI:1275506123
Name:GRIFFIN, JUDI DENNISE (MD)
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:DENNISE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:DENNISE
Other - Last Name:GRIFFIN-LANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3542
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 1H
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-464-2013
Practice Address - Fax:757-464-3046
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235963207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherMID ATLANTIC SOLUTIONS
VA7860606OtherAETNA
VA010085641Medicaid
VA176358OtherANTHEM
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherTRICARE
VA91226OtherSENTARA/OPTIMA
VA541595397OtherCIGNA
VA91226OtherSENTARA/OPTIMA
VA541595397OtherTRICARE