Provider Demographics
NPI:1184727208
Name:RAY, BRENDA JULIA (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JULIA
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7660 EAST PARHAM RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4309
Mailing Address - Country:US
Mailing Address - Phone:804-747-1176
Mailing Address - Fax:804-747-0874
Practice Address - Street 1:7660 EAST PARHAM RD
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4309
Practice Address - Country:US
Practice Address - Phone:804-747-1176
Practice Address - Fax:804-747-0874
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6034616Medicaid
0101034404OtherLIC TO PRACTICE MED IN ST
VA016751B34Medicare PIN
B07792Medicare UPIN
VA110001233Medicare PIN