Provider Demographics
NPI:1952398232
Name:GRIFFIN MARTIN, THERESA ANN (PAC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:GRIFFIN MARTIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:MITRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:100 KERRY CT APT 1212
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3081
Mailing Address - Country:US
Mailing Address - Phone:330-503-7691
Mailing Address - Fax:
Practice Address - Street 1:110 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2685
Practice Address - Country:US
Practice Address - Phone:724-374-3468
Practice Address - Fax:724-258-8914
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000540RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073657Medicaid
OH0073657Medicaid
S46835Medicare UPIN