Healthcare Provider Details

I. General information

NPI: 1659728335
Provider Name (Legal Business Name): DERWIN PEARSON GRAY II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LIBERTY ST
CHESAPEAKE VA
23324-2637
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-917-5716
  • Fax: 757-524-4396
Mailing address:
  • Phone: 757-842-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101269795
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: