Healthcare Provider Details

I. General information

NPI: 1962432880
Provider Name (Legal Business Name): WALTER J GRIFFITHS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 OAK GROVE AVE
BRATTLEBORO VT
05301-6642
US

IV. Provider business mailing address

15 HAPGOOD ST
BELLOWS FALLS VT
05101-1507
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-0307
  • Fax:
Mailing address:
  • Phone: 802-275-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number042-0005283
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number042.000528
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: