Healthcare Provider Details

I. General information

NPI: 1679644082
Provider Name (Legal Business Name): JOHN P GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BEEKMAN ST
PLATTSBURGH NY
12901-1438
US

IV. Provider business mailing address

PO BOX 2868
PLATTSBURGH NY
12901-0259
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7100
  • Fax: 518-562-7972
Mailing address:
  • Phone: 518-562-7900
  • Fax: 518-562-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number146929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: