Provider Demographics
NPI:1902849250
Name:GRIFFIN FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:GRIFFIN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-436-9600
Mailing Address - Street 1:32427 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3408
Mailing Address - Country:US
Mailing Address - Phone:302-436-9600
Mailing Address - Fax:302-436-6260
Practice Address - Street 1:32427 LIGHTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3408
Practice Address - Country:US
Practice Address - Phone:302-436-9600
Practice Address - Fax:302-436-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02341Medicare PIN
MD275PMedicare PIN