Healthcare Provider Details

I. General information

NPI: 1841427556
Provider Name (Legal Business Name): BENJAMIN LEO GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST 1 CATHCART
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

250 TRAVELODGE DR
EL CAJON CA
92020-4126
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-2230
  • Fax:
Mailing address:
  • Phone: 215-829-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2009013685
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35.122936
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD454361
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number174875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: