Healthcare Provider Details

I. General information

NPI: 1871527945
Provider Name (Legal Business Name): LAWRENCE N GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRIFFIN ROAD ATLANTIC PLASTIC SURGERY SUITE B
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

100 GRIFFIN RD SUITE B
PORTSMOUTH NH
03801-7113
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-8819
  • Fax: 603-427-2540
Mailing address:
  • Phone: 603-431-8819
  • Fax: 603-427-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number7057
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number011903
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC41323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: