Provider Demographics
NPI:1881873495
Name:GRAY, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HIGHLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-8484
Mailing Address - Fax:513-487-2315
Practice Address - Street 1:3001 HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8484
Practice Address - Fax:513-487-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0946852084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry