Healthcare Provider Details

I. General information

NPI: 1679064604
Provider Name (Legal Business Name): CANDACE JENNA GRIFFITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4000
  • Fax:
Mailing address:
  • Phone: 610-237-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT215058
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME151485
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME151485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: