Provider Demographics
NPI:1588843015
Name:GRAY, EDWARD H (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COOPER PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:973-600-7447
Mailing Address - Fax:
Practice Address - Street 1:325 W GERMANTOWN PIKE STE 301
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4207
Practice Address - Country:US
Practice Address - Phone:610-275-2446
Practice Address - Fax:610-275-3266
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015241207RC0200X
NJ25MB07397600207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024880680002Medicaid
NJ8884102Medicaid
NJ064914Medicare PIN