Healthcare Provider Details

I. General information

NPI: 1578521811
Provider Name (Legal Business Name): KATHERINE MARY GYVES-RAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 HUDSON DR SUITE 210
HUDSON OH
44236-4451
US

IV. Provider business mailing address

3695 GREEN RD UNIT 22778
BEACHWOOD OH
44122-7939
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-1874
  • Fax: 866-461-7993
Mailing address:
  • Phone: 330-655-1874
  • Fax: 866-461-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number105670
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number051483
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-123977
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberDR.0048767
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number42098
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: