Provider Demographics
NPI:1730288762
Name:GRIFFING, MARK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:GRIFFING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2112 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5629
Mailing Address - Country:US
Mailing Address - Phone:315-735-6742
Mailing Address - Fax:315-735-3514
Practice Address - Street 1:2112 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5629
Practice Address - Country:US
Practice Address - Phone:315-735-6742
Practice Address - Fax:315-735-3514
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82163Medicare UPIN
NY38707BMedicare PIN