Provider Demographics
NPI:1205813102
Name:GRAYSON, HOWARD AVORY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:AVORY
Last Name:GRAYSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:114 WOODLAND STREET
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-7446
Practice Address - Fax:860-714-1508
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT024407207R00000X
CT24407208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001244079Medicaid
CT110008122Medicare ID - Type Unspecified
CT001244079Medicaid