=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659728335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DERWIN PEARSON GRAY II M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2016
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 LIBERTY ST
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23324-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-917-5716
-----------------------------------------------------
Fax | 757-524-4396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 667 KINGSBOROUGH SQ STE 101
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-842-4481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 0101269795
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------