Provider Demographics
NPI:1275635682
Name:GRAY, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-792-5558
Mailing Address - Fax:203-731-3213
Practice Address - Street 1:33 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-792-5558
Practice Address - Fax:203-731-3213
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027630207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00267OtherMEDICARE GROUP
Z5264OtherOXFORD
1058788OtherUNITED HEALTHCARE
CT001276302Medicaid
010027630CT01OtherANTHEM BCBS
2V2656OtherHLTHNET OF THE NORTHEAST
0062482003OtherCIGNA
027630OtherCONNECTICARE
D32595Medicare UPIN
CT001276302Medicaid
CT0198860002Medicare NSC
CT0198860001Medicare NSC
Z5264OtherOXFORD