1457687113 NPI number — ELVIN LAVERN GRIFFITH M.D.

Table of content: ELVIN LAVERN GRIFFITH M.D. (NPI 1457687113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457687113 NPI number — ELVIN LAVERN GRIFFITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFITH
Provider First Name:
ELVIN
Provider Middle Name:
LAVERN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFITH
Provider Other First Name:
ELVIN
Provider Other Middle Name:
LAVERN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457687113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 WILLIAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06516-6054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-859-5154
Provider Business Mailing Address Fax Number:
203-859-5662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
377 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-859-5154
Provider Business Practice Location Address Fax Number:
203-859-5662
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  48211 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)