1619325990 NPI number — DARIN GRAY PA

Table of content: DARIN GRAY PA (NPI 1619325990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619325990 NPI number — DARIN GRAY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
DARIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619325990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MERRIMACK ST
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843-1779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-691-5690
Provider Business Mailing Address Fax Number:
978-691-5693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 GILCREST ROAD
Provider Second Line Business Practice Location Address:
UNIT 100
Provider Business Practice Location Address City Name:
LONDONDERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-432-3178
Provider Business Practice Location Address Fax Number:
603-434-7468
Provider Enumeration Date:
05/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1167 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA5723 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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