Basic Information
| Provider Information | |||||||||
| NPI: | 1801985379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | THOMPSON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 W CHELTENHAM AVE | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190271046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158845715 | ||||||||
| FaxNumber: | 2158841442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1939 W CHELTENHAM AVE | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190271046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158845715 | ||||||||
| FaxNumber: | 2158841442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MAO51232 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | MA-051232 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.