MEDICARE: KERRI J GRAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0053284	MD

General Provider Information

NPI Number	:	1700880184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI J GRAY MD

Provider Business Mailing Address
First Line	:	10401 OLD GEORGETOWN RD STE 304
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1911
Country	:	US
Telephone Number	:	301-843-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 OLD GEORGETOWN RD STE 304
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1911
Country	:	US
Telephone Number	:	301-843-8008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/04/2022

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