Healthcare Provider Details

I. General information

NPI: 1285707521
Provider Name (Legal Business Name): LAWRENCE KEITH GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MERIT DRIVE
RICHMOND HTS OH
44143
US

IV. Provider business mailing address

1460 BURLINGTON RD
CLEVELAND HTS OH
44118-1261
US

V. Phone/Fax

Practice location:
  • Phone: 216-261-1500
  • Fax: 216-261-8970
Mailing address:
  • Phone: 216-261-1500
  • Fax: 216-261-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35048187G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: