Provider Demographics
NPI:1124051958
Name:GRIFFIN, VIVIAN L (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:L
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:PO BOX 785802
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-5802
Mailing Address - Country:US
Mailing Address - Phone:855-709-4535
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:655 S BAY RD
Practice Address - Street 2:STE 5B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4660
Practice Address - Country:US
Practice Address - Phone:302-678-4688
Practice Address - Fax:302-678-4625
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003731207L00000X
MDD0063951207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00127363OtherRAILROAD MEDICARE
DE013565D99Medicare PIN
DEP00127363OtherRAILROAD MEDICARE