Basic Information
| Provider Information | |||||||||
| NPI: | 1629360680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIGGS | ||||||||
| FirstName: | CORNELIA | ||||||||
| MiddleName: | LITTLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 FRUIT ST WRN 1128 | ||||||||
| Address2: | DEPARTMENT OF PEDIATRIC SURGERY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177242913 | ||||||||
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| Address1: | 55 FRUIT ST DEPT OF | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 260324 | MA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.