Provider Demographics
NPI:1255471405
Name:RAY, THOMAS J (CP, BOCO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RAY
Suffix:
Gender:M
Credentials:CP, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEADOWMONT VILLAGE CIR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7505
Mailing Address - Country:US
Mailing Address - Phone:919-929-5550
Mailing Address - Fax:919-929-5572
Practice Address - Street 1:400 MEADOWMONT VILLAGE CIR
Practice Address - Street 2:SUITE 425
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7505
Practice Address - Country:US
Practice Address - Phone:919-929-5550
Practice Address - Fax:919-929-5572
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP003475174400000X
NCC50369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795243Medicaid