MEDICARE: DR. EDWARD H. GRAY DO

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	OS015241	PA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MB07397600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588843015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD H. GRAY DO

Provider Business Mailing Address
First Line	:	1 COOPER PLZ
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1461
Country	:	US
Telephone Number	:	973-600-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W GERMANTOWN PIKE STE 301
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19403-4207
Country	:	US
Telephone Number	:	610-275-2446
Fax Number	:	610-275-3266

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	05/28/2020

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