Provider Demographics
NPI:1487758934
Name:GRIFFITH, NANCY W (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4355
Mailing Address - Country:US
Mailing Address - Phone:765-521-3161
Mailing Address - Fax:765-521-2635
Practice Address - Street 1:1516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4355
Practice Address - Country:US
Practice Address - Phone:765-521-3161
Practice Address - Fax:765-521-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027773A207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134800AMedicaid
IN200459450Medicaid
INP01430097OtherRAILROAD MEDICARE
INB28770Medicare UPIN
ININ1563Medicare PIN
INP01430097OtherRAILROAD MEDICARE