Provider Demographics
NPI:1649352246
Name:GRIGGS, JOHN EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDGAR
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 434
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2301
Mailing Address - Country:US
Mailing Address - Phone:413-737-2981
Mailing Address - Fax:413-737-1366
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 434
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-737-2981
Practice Address - Fax:413-737-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47626173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0114782OtherAETNA
MA721910OtherTUFTS
MA0184624Medicaid
MA12794OtherHEALTH NEW ENGLAND
MA21632OtherHARVARD PILGRIM
MA985269OtherNETWORK HEALTH
MA484153OtherCONNECTICARE
MAN51797OtherBLUE CROSS AND BLUE SHIEL
MA721910OtherTUFTS