Healthcare Provider Details

I. General information

NPI: 1124101969
Provider Name (Legal Business Name): ROBERT WELDON CRAIG-GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 W. PERIMETER RD 79TH AMDS/SGPF
ANDREWS AFB MD
20762-0000
US

IV. Provider business mailing address

1210 RING BILL LOOP
UPPER MARLBORO MD
20774-7171
US

V. Phone/Fax

Practice location:
  • Phone: 240-857-5282
  • Fax: 240-857-3073
Mailing address:
  • Phone: 301-218-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number01055793A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01055793A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: