Provider Demographics
NPI:1649043472
Name:GRAYS, VICTOR SR
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:GRAYS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 PERSIMMON TREE CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1133
Mailing Address - Country:US
Mailing Address - Phone:443-621-2225
Mailing Address - Fax:
Practice Address - Street 1:3125 PERSIMMON TREE CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1133
Practice Address - Country:US
Practice Address - Phone:443-621-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD343900000X146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic