1508958026 NPI number — CHARLES E GRIFFITH III DO

Table of content: CHARLES E GRIFFITH III DO (NPI 1508958026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508958026 NPI number — CHARLES E GRIFFITH III DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFITH
Provider First Name:
CHARLES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508958026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 TOWNE SQUARE DR STE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-9440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-988-0234
Provider Business Mailing Address Fax Number:
717-703-0121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 TOWNE SQUARE DR STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-9440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-988-0234
Provider Business Practice Location Address Fax Number:
717-703-0121
Provider Enumeration Date:
09/29/2006

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: 207RR0500X , with the licence number:  2006-00259 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: H0065839 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: OS016218 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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