Provider Demographics
NPI:1982478772
Name:GRAY, ATEEYA M
Entity Type:Individual
Prefix:
First Name:ATEEYA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LOG CANOE CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2127
Mailing Address - Country:US
Mailing Address - Phone:443-249-3405
Mailing Address - Fax:443-249-3123
Practice Address - Street 1:137 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2127
Practice Address - Country:US
Practice Address - Phone:443-249-3405
Practice Address - Fax:443-249-3123
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy