Provider Demographics
NPI:1922576909
Name:RAY, PHYLLIS A
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W BENFIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2220
Mailing Address - Country:US
Mailing Address - Phone:877-377-6112
Mailing Address - Fax:844-922-4329
Practice Address - Street 1:9607 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4129
Practice Address - Country:US
Practice Address - Phone:443-213-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine