Provider Demographics
NPI:1457301566
Name:GAY, GARY LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LESLIE
Last Name:GAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 LATOUR LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4544
Mailing Address - Country:US
Mailing Address - Phone:443-567-0134
Mailing Address - Fax:410-734-9502
Practice Address - Street 1:3006 CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1808
Practice Address - Country:US
Practice Address - Phone:443-567-0134
Practice Address - Fax:410-734-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00513992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry