Provider Demographics
NPI:1578568986
Name:GRIFFIN, MARY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:MCCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:ONE BALA PLAZA
Mailing Address - Street 2:SUITE 620
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-664-3300
Mailing Address - Fax:610-664-1151
Practice Address - Street 1:ONE BALA PLAZA
Practice Address - Street 2:SUITE 620
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-664-3300
Practice Address - Fax:610-664-1151
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS012012OtherSTATE LICENSE
PAOS012012OtherSTATE LICENSE
PABM8405462OtherDEA
PA045043Medicare ID - Type Unspecified