Provider Demographics
NPI:1457500704
Name:GRIFFIN, MATTHEW PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PATRICK
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 1:116 S EUCLID AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2187
Mailing Address - Country:US
Mailing Address - Phone:312-509-3930
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3724
Practice Address - Country:US
Practice Address - Phone:573-581-8500
Practice Address - Fax:573-581-5397
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09729800207R00000X
RILP01545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty