Healthcare Provider Details

I. General information

NPI: 1700950409
Provider Name (Legal Business Name): ROY N GAY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CHESTNUT ST 1ST FLOOR
PHILADELPHIA PA
19103-4401
US

IV. Provider business mailing address

411 E GOWEN AVE
PHILADELPHIA PA
19119-1025
US

V. Phone/Fax

Practice location:
  • Phone: 215-988-0508
  • Fax: 215-988-0518
Mailing address:
  • Phone: 215-988-0508
  • Fax: 215-988-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD 037685
License Number StatePA

VIII. Authorized Official

Name: MS. CATHLEEN MARGARET WLOCK
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 610-832-5903