Provider Demographics
NPI:1104225135
Name:MCCRAY, TIA (NP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1627 PARKRIDGE CIR APT 125
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2808
Mailing Address - Country:US
Mailing Address - Phone:301-512-6429
Mailing Address - Fax:
Practice Address - Street 1:5500 KNOLL NORTH DR STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2363
Practice Address - Country:US
Practice Address - Phone:240-747-7785
Practice Address - Fax:833-359-1348
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR172203363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health