Provider Demographics
NPI:1649372566
Name:RAY, DIPES K (MD, MRCP)
Entity type:Individual
Prefix:
First Name:DIPES
Middle Name:K
Last Name:RAY
Suffix:
Gender:M
Credentials:MD, MRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8672
Mailing Address - Country:US
Mailing Address - Phone:252-435-1275
Mailing Address - Fax:855-348-4480
Practice Address - Street 1:446 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8672
Practice Address - Country:US
Practice Address - Phone:252-435-1275
Practice Address - Fax:855-348-4480
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235920207R00000X
NC9701854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
129829725OtherTRICARE
49-D1022562OtherCLIA
7687230OtherAETNA
VA010155941Medicaid
3342321OtherCIGNA
61697OtherOPTIMA/SENTARA
861095408OtherVA HEALTH NETWORK
VA173326OtherANTHEM - BCBS
VA173327OtherANTHEM - SUFFOLK
VAP00099937OtherRAILROAD MEDICARE
VAP00099937OtherRAILROAD MEDICARE
49-D1022562OtherCLIA