Provider Demographics
NPI:1275505737
Name:GRAY, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:907 GOOSE CREEK RD
Practice Address - Street 2:SUITE A03
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2302
Practice Address - Country:US
Practice Address - Phone:540-213-8832
Practice Address - Fax:540-213-5500
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146628OtherSOUTHERN HEALTH
VA5853524OtherVA PREMIER
VA700011404OtherCIGNA
VA2180533OtherFIRST HEALTH
VA005853524Medicaid
VA285564OtherANTHEM
VA41812OtherSENTARA
VA5853524OtherVA PREMIER
VAE64591Medicare UPIN
VA1100011404Medicare ID - Type Unspecified
VAGC1100Medicare PIN
VA005853524Medicaid
VA146628OtherSOUTHERN HEALTH