Provider Demographics
NPI:1639119191
Name:WRAY, VIRGINIA M (DO)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:M
Last Name:WRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:M
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 E PARK AVE
Mailing Address - Street 2:STE 312
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6706
Mailing Address - Country:US
Mailing Address - Phone:814-689-3156
Mailing Address - Fax:814-689-1954
Practice Address - Street 1:1850 E PARK AVE
Practice Address - Street 2:STE 312
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-689-3156
Practice Address - Fax:814-689-1954
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009416L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101135804Medicaid
PA101135804Medicaid
010618Medicare PIN
G71773Medicare UPIN