Provider Demographics
NPI:1013947142
Name:GRAY, ANGELA LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LORRAINE
Last Name:GRAY
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 1:1608 S J ST FL 1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7501
Mailing Address - Fax:206-246-0468
Practice Address - Street 1:1608 S J ST FL 1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7501
Practice Address - Fax:206-246-0468
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117908207VM0101X
NC2015-00395207VM0101X
WAMD60930373207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010232675OtherBLUE CHOICE
WA2137369Medicaid
NY02565180Medicaid
NY7380613OtherAETNA
NYP020232675OtherBLUE SHIELD OF ROCHESTER
NY140226CKOtherPREFERRED CARE
FL010203600Medicaid
FL14T9XOtherBCBS
FL14T9XOtherBCBS
FL010203600Medicaid