Provider Demographics
NPI:1992989008
Name:GRIFFITH, THOMAS LYLE (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LYLE
Last Name:GRIFFITH
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 1:8102 KOEHLER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1232
Mailing Address - Country:US
Mailing Address - Phone:304-851-4229
Mailing Address - Fax:
Practice Address - Street 1:8102 KOEHLER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1232
Practice Address - Country:US
Practice Address - Phone:304-851-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty