Provider Demographics
NPI:1558783282
Name:GRIFFITH, SEAN J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:J
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 TIBBS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8127
Mailing Address - Country:US
Mailing Address - Phone:412-552-9074
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1283
Practice Address - Country:US
Practice Address - Phone:304-265-0400
Practice Address - Fax:304-265-6443
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN598643367500000X
WVAPRN90837367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid
NCPENDINGOtherMEDICARE
SCPENDINGOtherMEDICAID SOUTH CAROLINA