MEDICARE: DR. DAVID G RAY PHD

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	103TC0700X	Clinical Psychologist	0810002965	VA

General Provider Information

NPI Number	:	1679626014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G RAY PHD

Provider Business Mailing Address
First Line	:	6212 FALCON LANDING CT
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-2528
Country	:	US
Telephone Number	:	703-738-9203
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE
Second Line	:
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:	202-767-0611
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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