Provider Demographics
NPI:1427040088
Name:GRAY, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
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 1:1599 SOMERSET AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-0000
Mailing Address - Country:US
Mailing Address - Phone:814-467-5600
Mailing Address - Fax:814-467-5605
Practice Address - Street 1:1599 SOMERSET AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-0000
Practice Address - Country:US
Practice Address - Phone:814-467-5600
Practice Address - Fax:814-467-5605
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009675850002Medicaid
PA1009675850002Medicaid
079363VU6Medicare PIN