Provider Demographics
NPI:1659402220
Name:GRIFFIN, MARY HOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY HOPE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MEMORIAL DR STE 402
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1074
Mailing Address - Country:US
Mailing Address - Phone:574-400-4550
Mailing Address - Fax:574-400-4551
Practice Address - Street 1:621 MEMORIAL DR STE 402
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-400-4550
Practice Address - Fax:574-400-4551
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066608A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200969080Medicaid
IN000000789444OtherBCBS BMG CENTENNIAL
IN000000640442OtherBCBS BMG SOUTHEAST
IN000000640863OtherBCBS BMG CENTRAL
IN000000640863OtherBCBS BMG CENTRAL
IN200969080Medicaid