MEDICARE: MADISON GRIFFIN

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	363A00000X	Physician Assistant	MA067811	PA

General Provider Information

NPI Number	:	1316870686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON GRIFFIN

Provider Business Mailing Address
First Line	:	500 UNIVERSITY DRIVE
Second Line	:	MC CA410
City	:	HERSHEY
State	:	PA
Zip	:	17033-2360
Country	:	US
Telephone Number	:	800-243-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	4230 CRUMS MILL RD STE 100
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2898
Country	:	US
Telephone Number	:	717-233-6171
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ MADISON GRIFFIN ” Practice Location

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