Healthcare Provider Details

I. General information

NPI: 1154568384
Provider Name (Legal Business Name): THE GRIFFIN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SEYMOUR AVE
DERBY CT
06418-1338
US

IV. Provider business mailing address

350 SEYMOUR AVE
DERBY CT
06418-1338
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-1260
  • Fax: 203-732-1194
Mailing address:
  • Phone: 203-732-1260
  • Fax: 203-732-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number0034
License Number StateCT

VIII. Authorized Official

Name: MR. PATRICK CHARMEL
Title or Position: CEO
Credential:
Phone: 203-732-7513