Healthcare Provider Details

I. General information

NPI: 1386901239
Provider Name (Legal Business Name): CHANTEL ANNETTE GRAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 03/31/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8000
  • Fax:
Mailing address:
  • Phone: 614-293-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.128998
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD483807
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35128998
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: