Provider Demographics
NPI:1407315765
Name:TYREE, GRIFFIN A (MD)
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:A
Last Name:TYREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GRIFFIN
Other - Middle Name:AYAZ
Other - Last Name:TYREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2826
Practice Address - Country:US
Practice Address - Phone:617-318-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2903012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110157142AMedicaid