Provider Demographics
NPI:1861482317
Name:WRAY, SHIRLEY H (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:H
Last Name:WRAY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST WAC 837
Practice Address - Street 2:NEUROLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-5537
Practice Address - Fax:617-726-7714
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA321402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM07631OtherBCBS MA
MA2001578Medicaid
MA702197OtherTUFTS HEALTH PLAN
MA2001578Medicaid
MAM07631OtherBCBS MA