Basic Information
| Provider Information | |||||||||
| NPI: | 1629041587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LAMONT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 PENNSYLVANIA AVENUE NW | ||||||||
| Address2: | SUITE 10 409A | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413398 | ||||||||
| FaxNumber: | 2027413396 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 PENNSYLVANIA AVENUE NW | ||||||||
| Address2: | MEDICAL FACULTY ASSOCIATES INC | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027412900 | ||||||||
| FaxNumber: | 2027412891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P2900X | MD20791 | DC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | 2084P2900X | 0101055200 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | 2084P2900X | 07657 | MS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0D7114095 | 05 | VA | MEDICAID | 12359150D | 05 | MD | MEDICAID |