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General NPI Number Information
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NPI Number | 1467271098
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Entity Type | Individual
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Provider Name | NICHOLE GRAY
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 4604 SPOTSYLVANIA PKWY STE 340
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-7767
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Country | US
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Telephone | 540-200-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 202 VICTORIA DR
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City | RUTHER GLEN
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State | VA
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Zip | 22546-1034
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Country | US
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Telephone | 301-456-5078
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0024191440
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License Number State | VA
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