Individual
KERIANN NICKOLA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 SCENERY DR., STATE COLLEGE, PA 16801-5602
(814) 231-4560
(814) 231-6246
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
246232
NY
207RH0003X
Hematology & Oncology Physician
Primary
MD456589
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464500
MEDICARE
PA
Enumeration date
06/28/2007
Last updated
05/21/2021
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