Provider Demographics
NPI:1760577514
Name:RAY, DAVID G (MED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:RAY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2202
Mailing Address - Country:US
Mailing Address - Phone:717-248-1766
Mailing Address - Fax:717-248-8551
Practice Address - Street 1:43 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2202
Practice Address - Country:US
Practice Address - Phone:717-248-1766
Practice Address - Fax:717-248-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004472-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist