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General NPI Number Information
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NPI Number | 1649411539
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Entity Type | Individual
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Provider Name | LISA MARIE GRAY D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 4550 LEE HWY STE C
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City | DUBLIN
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State | VA
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Zip | 24084-3802
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Country | US
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Telephone | 540-980-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 BRAEBURN DR
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City | SALEM
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State | VA
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Zip | 24153-7357
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Country | US
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Telephone | 540-772-3743
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101020367
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0102204469
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License Number State | VA
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