Provider Demographics
NPI:1326050964
Name:GRAY, DERWIN P (MD)
Entity Type:Individual
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First Name:DERWIN
Middle Name:P
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 MADISON PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5179
Mailing Address - Country:US
Mailing Address - Phone:757-547-2322
Mailing Address - Fax:757-547-9439
Practice Address - Street 1:1101 MADISON PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5179
Practice Address - Country:US
Practice Address - Phone:757-547-2322
Practice Address - Fax:757-547-9439
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-12-27
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Provider Licenses
StateLicense IDTaxonomies
VA010104256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA160001618Medicare PIN