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General NPI Number Information
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NPI Number | 1205941713
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Entity Type | Individual
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Provider Name | MARY B GRAY RPA-C
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 113 HOLLAND AVE
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City | ALBANY
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State | NY
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Zip | 12208-3410
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Country | US
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Telephone | 518-626-6077
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Fax | 518-626-6045
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Provider Business Mailing Address
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Address Line | 22 GENESEE AVE
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City | RENSSELAER
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State | NY
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Zip | 12144-3612
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Country | US
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Telephone | 518-449-2332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 005232-1
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License Number State | NY
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