Healthcare Provider Details

I. General information

NPI: 1588339428
Provider Name (Legal Business Name): GRAY FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 09/12/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 OLD GEORGETOWN RD STE 304
BETHESDA MD
20814-1911
US

IV. Provider business mailing address

10401 OLD GEORGETOWN RD STE 304
BETHESDA MD
20814-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-843-8008
  • Fax:
Mailing address:
  • Phone: 301-843-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA JORDAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 240-372-9414