Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 0024172520 | VA |
NPI | 1285614685 |
---|---|
Provider Name | Roberta Gray |
First Address | Harrisonburg, VA 22801-8036 |
Second Address | Harrisonburg, VA 22801-8036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C06068 | (05) | VA |
S67419 | (02) | NJ |