Provider Demographics
NPI:1821024209
Name:MCCRAY, LAURA WRIGHT (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:WRIGHT
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUSANNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1775 WILLISTON ROAD
Mailing Address - Street 2:SOUTH BURLINGTON FAMILY PRACTICE
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-847-8500
Mailing Address - Fax:
Practice Address - Street 1:1775 WILLISTON ROAD
Practice Address - Street 2:SOUTH BURLINGTON FAMILY PRACTICE
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-847-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425756207Q00000X
VT0420011595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014991Medicaid
PA1012929400001Medicaid
VT1014991Medicaid
PA1012929400001Medicaid
130515Medicare UPIN