Provider Demographics
NPI:1639108509
Name:GRIFFITH, FRED FLYNT (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:FLYNT
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BUILDING 11
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-431-1860
Mailing Address - Fax:401-435-0328
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING 11
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-431-1860
Practice Address - Fax:401-435-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI57042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2328628OtherAETNA
RI2643OtherNEIGHBORHOOD HEALTH
RI211703OtherBLUE CROSS BLUE SHIELD
RI1730485001OtherCIGNA
RI0500305OtherUNITED HEALTHCARE
RIFG33117Medicaid
RI405987OtherBC/BS BLUE CHIP
RIFG33117Medicaid