Healthcare Provider Details

I. General information

NPI: 1588604698
Provider Name (Legal Business Name): TERENCE GRAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ENTERPRISE DR STE 101
SCARBOROUGH ME
04074-7662
US

IV. Provider business mailing address

17 CHANNEL VIEW RD
CAPE ELIZABETH ME
04107-2929
US

V. Phone/Fax

Practice location:
  • Phone: 207-289-6726
  • Fax: 207-289-1219
Mailing address:
  • Phone: 860-944-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042675
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number210744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: