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NPI Code Detail

MEDICARE: CHARLES GRAY M.D.

MEDICARE: CHARLES GRAY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD058820LPA

General Provider Information

NPI Number : 1366505380
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES GRAY M.D.
Provider Business Mailing Address
First Line : 649 S HENDERSON RD
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-3529
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2055 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-3832
Country : US
Telephone Number : 215-427-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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