Provider Demographics
NPI:1568162139
Name:MCCRAY, ELLESSE DARCEL
Entity Type:Individual
Prefix:
First Name:ELLESSE
Middle Name:DARCEL
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7523
Mailing Address - Country:US
Mailing Address - Phone:443-410-9886
Mailing Address - Fax:
Practice Address - Street 1:4013 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7523
Practice Address - Country:US
Practice Address - Phone:443-410-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program