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Individual
MATTHEW GRISWOLD ELY III
Active
Individual
MATTHEW GRISWOLD ELY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
016178
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010016178CT01
ANTHEM BC/BS
CT
01
—
076334
CONNECTICARE
CT
01
—
0V4532
HEALTH NET
CT
01
—
12077
HEALTH NEW ENGLAND
CT
01
—
2053938
AETNA
CT
05
—
3164896
—
MA
01
—
4416097 001
CIGNA
CT
01
—
P2043630
OXFORD
CT
Enumeration date
07/29/2005
Last updated
07/09/2007
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