MEDICARE: JUDI DENNISE GRIFFIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101235963	VA
2	208M00000X	Hospitalist Physician	0101235963	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	541595397	OTHER	VA	MID ATLANTIC SOLUTIONS
2	7860606	OTHER	VA	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	176358	OTHER	VA	ANTHEM
5	541595397	OTHER	VA	VIRGINIA HEALTH NETWORK
6	541595397	OTHER	VA	PRIVATE HEALTHCARE SYSTEM
7	541595397	OTHER	VA	TRICARE
8	91226	OTHER	VA	SENTARA/OPTIMA
9	541595397	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1275506123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDI DENNISE GRIFFIN MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3542
Fax Number	:	757-686-0230

Provider Business Practice Location Address
First Line	:	816 INDEPENDENCE BLVD
Second Line	:	SUITE 1H
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6010
Country	:	US
Telephone Number	:	757-464-2013
Fax Number	:	757-464-3046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	01/26/2024

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