Healthcare Provider Details

I. General information

NPI: 1275506123
Provider Name (Legal Business Name): JUDI DENNISE GRIFFIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDI DENNISE GRIFFIN-LANEY

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 INDEPENDENCE BLVD SUITE 1H
VIRGINIA BEACH VA
23455-6010
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-464-2013
  • Fax: 757-464-3046
Mailing address:
  • Phone: 757-686-3542
  • Fax: 757-686-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101235963
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101235963
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: