Provider Demographics
NPI:1962432880
Name:GRIFFITHS, WALTER J (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:GRIFFITHS
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 1:15 HAPGOOD ST
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1507
Mailing Address - Country:US
Mailing Address - Phone:802-275-8734
Mailing Address - Fax:
Practice Address - Street 1:187 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6642
Practice Address - Country:US
Practice Address - Phone:802-257-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005283207QG0300X
VT042.000528207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004538Medicaid
VTB85472Medicare UPIN
VT0004538Medicaid