Provider Demographics
NPI:1417978263
Name:RAY, KEREN (DO)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 EXPERIMENT FARM RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1071
Mailing Address - Country:US
Mailing Address - Phone:937-914-7179
Mailing Address - Fax:937-522-9960
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3908
Practice Address - Country:US
Practice Address - Phone:937-439-3600
Practice Address - Fax:937-439-3786
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007950207R00000X
OH34.007950208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2435878Medicaid
OHH96736Medicare UPIN
OH2435878Medicaid