Healthcare Provider Details

I. General information

NPI: 1376551762
Provider Name (Legal Business Name): ADAM MCCOY GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 BUFORD RD
RICHMOND VA
23235-3422
US

IV. Provider business mailing address

1108 KENLEY WAY
RICHMOND VA
23226-2962
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-272-8806
  • Fax: 804-272-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101241657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: