Individual
RICHARD J GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7959 BUSTLETON AVE, PHILADELPHIA, PA 19152-3320
(215) 742-5662
(215) 742-5663
Mailing address
40 VALLEY STREAM PKWY, SUITE 100, MALVERN, PA 19355-1407
(610) 644-8900
(610) 644-8909
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD17704
DC
2085R0204X
Vascular & Interventional Radiology Physician
MD17704
DC
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD434194
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102173425
—
OR
01
—
125141RS8
MEDICARE
PA
01
—
MD434194
MEDICAL LICENSE NUMBER
PA
Enumeration date
10/25/2005
Last updated
02/01/2016
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