Healthcare Provider Details

I. General information

NPI: 1093739179
Provider Name (Legal Business Name): STEPHEN R GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD PATHOLOGY DEPARTMENT
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

5 PERRYRIDGE RD PATHOLOGY DEPARTMENT
GREENWICH CT
06830-4608
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3061
  • Fax: 203-863-3846
Mailing address:
  • Phone: 203-863-3061
  • Fax: 203-863-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number016129
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: