Provider Demographics
NPI:1588604698
Name:GRAY, TERENCE (DO)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHANNEL VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2929
Mailing Address - Country:US
Mailing Address - Phone:860-944-4708
Mailing Address - Fax:
Practice Address - Street 1:400 ENTERPRISE DR STE 101
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7662
Practice Address - Country:US
Practice Address - Phone:207-289-6726
Practice Address - Fax:207-289-1219
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210744207LP2900X
CT042675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine