Provider Demographics
NPI:1518109610
Name:RAY, ANITA J (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3720
Mailing Address - Fax:585-368-3723
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2334
Practice Address - Country:US
Practice Address - Phone:585-368-3720
Practice Address - Fax:585-368-3723
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY263758208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03588447Medicaid
NY03588447Medicaid
NYJ400167300/GRPBA0017Medicare PIN