Provider Demographics
NPI:1093817090
Name:RAY, SULEKHA (MD)
Entity Type:Individual
Prefix:
First Name:SULEKHA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 GAINSBOROUGH SQ STE 201
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1714
Mailing Address - Country:US
Mailing Address - Phone:757-410-8745
Mailing Address - Fax:757-410-8746
Practice Address - Street 1:113 GAINSBOROUGH SQ STE 201
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-410-8745
Practice Address - Fax:757-410-8746
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA861095408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
49D1022562OtherCLIA
861095408OtherVA HEALTH NETWORK
70343OtherOPTIMA/SENTARA
7596518OtherCIGNA
VAP00099937OtherRAILROAD MEDICARE
VA010057256Medicaid
VA114964OtherANTHEM - SUFFOLK
0007777515OtherAETNA
1109507OtherFIRST HEALTH
VA114879OtherANTHEM - BCBS
7596518OtherCIGNA
VA00V826P74Medicare ID - Type Unspecified