Healthcare Provider Details

I. General information

NPI: 1528077187
Provider Name (Legal Business Name): LINDA E. GRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST.
NEW HAVEN CT
06511
US

IV. Provider business mailing address

1450 CHAPEL ST.
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3388
  • Fax: 203-789-4037
Mailing address:
  • Phone: 203-789-3388
  • Fax: 203-789-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number032667
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: