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General NPI Number Information
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NPI Number | 1285590778
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Entity Type | Individual
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Provider Name | SEAN GRAY
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Gender | Male
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 163 VETERANS DR
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-7005
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Country | US
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Telephone | 802-295-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 72 HARDY HILL RD
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City | LEBANON
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State | NH
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Zip | 03766-2011
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Country | US
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Telephone |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 1679
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License Number State | NH
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