MEDICARE: DR. MARY ELIZABETH GRIFFIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	OS012012	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS012012	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1578568986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH GRIFFIN DO

Provider Business Mailing Address
First Line	:	ONE BALA PLAZA
Second Line	:	SUITE 620
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004
Country	:	US
Telephone Number	:	610-664-3300
Fax Number	:	610-664-1151

Provider Business Practice Location Address
First Line	:	ONE BALA PLAZA
Second Line	:	SUITE 620
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004
Country	:	US
Telephone Number	:	610-664-3300
Fax Number	:	610-664-1151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/07/2023

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