MEDICARE: DR. NICOLA S 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	174400000X	Specialist	MD420737	PA
2	2084P0800X	Psychiatry Physician	MD420737	PA
3	207Q00000X	Family Medicine Physician	MD420737	PA

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

General Provider Information

NPI Number	:	1982677878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLA S GRAY MD

Provider Business Mailing Address
First Line	:	PO BOX 858
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-0858
Country	:	US
Telephone Number	:	800-243-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N 3RD ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-1904
Country	:	US
Telephone Number	:	717-782-4734
Fax Number	:	717-782-4727

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	04/28/2021

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