Provider Demographics
NPI:1285707521
Name:GRAY, LAWRENCE KEITH (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:KEITH
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1261
Mailing Address - Country:US
Mailing Address - Phone:216-261-1500
Mailing Address - Fax:216-261-8970
Practice Address - Street 1:3 MERIT DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:216-261-1500
Practice Address - Fax:216-261-8970
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048187G207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0697321Medicaid
000000277964OtherBCBS
000000277964OtherBCBS
0614425Medicare ID - Type Unspecified