Provider Demographics
NPI:1568562593
Name:MARK GRIFFING, MD
Entity type:Organization
Organization Name:MARK GRIFFING, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRIFFING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-735-6742
Mailing Address - Street 1:2112 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5629
Mailing Address - Country:US
Mailing Address - Phone:315-735-6742
Mailing Address - Fax:315-735-3514
Practice Address - Street 1:2112 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5629
Practice Address - Country:US
Practice Address - Phone:315-735-6742
Practice Address - Fax:315-735-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty