MEDICARE: DR. DERWIN PEARSON GRAY II 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
1	207V00000X	Obstetrics & Gynecology Physician	0101269795	VA

General Provider Information

NPI Number	:	1659728335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERWIN PEARSON GRAY II M.D.

Provider Business Mailing Address
First Line	:	667 KINGSBOROUGH SQ STE 101
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4999
Country	:	US
Telephone Number	:	757-842-4481
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 LIBERTY ST
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2637
Country	:	US
Telephone Number	:	757-917-5716
Fax Number	:	757-524-4396

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	03/20/2025

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