Provider Demographics
NPI:1780611640
Name:GRAY, MICHAEL A (RPA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:GRAY
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1026
Mailing Address - Country:US
Mailing Address - Phone:716-778-7237
Mailing Address - Fax:716-778-7303
Practice Address - Street 1:2610 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1026
Practice Address - Country:US
Practice Address - Phone:716-778-7237
Practice Address - Fax:716-778-7303
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010116-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570510002OtherBCBS
NY00026918302OtherUNIVERA
NY9512727OtherINDEPENDENT HEALTH
NY00026918302OtherUNIVERA
NY9512727OtherINDEPENDENT HEALTH