Healthcare Provider Details

I. General information

NPI: 1467849703
Provider Name (Legal Business Name): KATHERINE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5871 GROVELAND STATION RD
MOUNT MORRIS NY
14510-9767
US

IV. Provider business mailing address

4907 W LAKE RD
GENESEO NY
14454-9609
US

V. Phone/Fax

Practice location:
  • Phone: 585-658-4023
  • Fax:
Mailing address:
  • Phone: 585-658-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number866299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: