Provider Demographics
NPI:1780774174
Name:GRIFFIN, MARCUS (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:GRIFFIN
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 1:221 PIIKEA AVE # A
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8268
Mailing Address - Country:US
Mailing Address - Phone:808-270-0491
Mailing Address - Fax:808-874-6887
Practice Address - Street 1:221 PIIKEA AVE # A
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8268
Practice Address - Country:US
Practice Address - Phone:808-270-0491
Practice Address - Fax:808-874-6887
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8609173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03688202Medicaid
HIJ04059-0OtherHMSA
HI52800Medicare ID - Type Unspecified
HI03688202Medicaid