1700950409 NPI number — ROY N GAY MD PC

Table of content: (NPI 1700950409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700950409 NPI number — ROY N GAY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY N GAY MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROY N GAY MD
Provider Other Organization Name Type Code:
5
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:
1700950409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 E GOWEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19119-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-988-0508
Provider Business Mailing Address Fax Number:
215-988-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2116 CHESTNUT ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19103-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-988-0508
Provider Business Practice Location Address Fax Number:
215-988-0518
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WLOCK
Authorized Official First Name:
CATHLEEN
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
610-832-5903

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  MD 037685 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD 037685 . This is a "MEDICAL LICENCES NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00834773 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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