Provider Demographics
NPI:1063411122
Name:GRIFFITH, SCOTT ALAN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4524
Mailing Address - Country:US
Mailing Address - Phone:814-835-8258
Mailing Address - Fax:814-838-0104
Practice Address - Street 1:2640 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4524
Practice Address - Country:US
Practice Address - Phone:814-835-8258
Practice Address - Fax:814-838-0104
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061759L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016006700005Medicaid
PA997402OtherPA BLUE SHIELD
PA180028526OtherRR MEDICARE
PAG31582Medicare UPIN
PA0016006700005Medicaid
PA180028526OtherRR MEDICARE