Provider Demographics
NPI:1609097716
Name:GRIFFITH, JARED ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ANTHONY
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2591 MIAMISBURG CENTERVILLE ROAD
Mailing Address - Street 2:STE 302
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-433-7622
Mailing Address - Fax:937-433-7656
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-4803
Practice Address - Fax:937-440-4381
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010160462085R0202X
OH34.0098962085R0202X, 2085N0700X
CT0479112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3108934Medicaid
OH4298651Medicare PIN