=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851277156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOT ANESTHESIOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 RIDEOUT RD
-----------------------------------------------------
City | HOLLIS
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03049-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-484-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 923 ELM ST # 102
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03101-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-484-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. DENNIS WAYNE GRAY JR.
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 603-484-9777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------