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1407846090

NPI Code Detail

MEDICARE: RICHARD J GRAY MD

MEDICARE: RICHARD J GRAY MD

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
1	2085R0202X	Diagnostic Radiology Physician	MD17704	DC
2	2085R0204X	Vascular & Interventional Radiology Physician	MD17704	DC
3	2085R0204X	Vascular & Interventional Radiology Physician	MD434194	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125141RS8	OTHER	PA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MD434194	OTHER	PA	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1407846090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J GRAY MD

Provider Business Mailing Address
First Line	:	40 VALLEY STREAM PKWY
Second Line	:	SUITE 100
City	:	MALVERN
State	:	PA
Zip	:	19355-1407
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	610-644-8909

Provider Business Practice Location Address
First Line	:	7959 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3320
Country	:	US
Telephone Number	:	215-742-5662
Fax Number	:	215-742-5663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	02/01/2016

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Directions to “ RICHARD J GRAY MD” Practice Location

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