Provider Demographics
NPI:1679526891
Name:GRAY, CHRISTA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LYNN
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 COWPER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2230
Mailing Address - Country:US
Mailing Address - Phone:919-609-2832
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-873-9533
Practice Address - Fax:919-873-9821
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82099207L00000X, 208VP0000X, 208VP0014X
NC200601829207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC809441OtherPARTNERS
CA00A820990OtherBLUE SHIELD
NC1460033OtherCIGNA
NC144M3OtherBCBC
NC194940OtherMEDCOST
NC5905906Medicaid
NCP00393298OtherRAILRAOD-MEDICARE
NC2061823Medicare PIN
NC194940OtherMEDCOST
CA00A820990Medicare ID - Type Unspecified
NC1460033OtherCIGNA