Provider Demographics
NPI:1982631628
Name:RAY, MARIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:RAY
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:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 ELM ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1956
Practice Address - Country:US
Practice Address - Phone:541-812-4580
Practice Address - Fax:541-928-3169
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG54947Medicare UPIN