Provider Demographics
NPI:1477919769
Name:DEVON GRAY, L.AC.
Entity Type:Organization
Organization Name:DEVON GRAY, L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE & HERBAL MEDICINE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:804-363-7559
Mailing Address - Street 1:8407 GREENWOOD AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6770
Mailing Address - Country:US
Mailing Address - Phone:804-363-7559
Mailing Address - Fax:
Practice Address - Street 1:8505 FENTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4497
Practice Address - Country:US
Practice Address - Phone:301-565-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02276171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty