Provider Demographics
NPI:1700955671
Name:GRIFFIN, ELAINE C (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:C
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-379-1156
Mailing Address - Fax:336-370-0442
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-379-1156
Practice Address - Fax:336-370-0442
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16117OtherPARTNERS MEDICARE
NC67071OtherMEDCOST
NC8937236Medicaid
NC37236OtherBCBS OF NC
NC2232029AMedicare PIN
NC8937236Medicaid