Provider Demographics
NPI:1700950409
Name:ROY N GAY MD PC
Entity Type:Organization
Organization Name:ROY N GAY MD PC
Other - Org Name:ROY N GAY MD
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:WLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-832-5903
Mailing Address - Street 1:411 E GOWEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1025
Mailing Address - Country:US
Mailing Address - Phone:215-988-0508
Mailing Address - Fax:215-988-0518
Practice Address - Street 1:2116 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4401
Practice Address - Country:US
Practice Address - Phone:215-988-0508
Practice Address - Fax:215-988-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 037685173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD 037685OtherMEDICAL LICENCES NUMBER
PA00834773Medicaid
PA00834773Medicaid
PAC29875Medicare UPIN