Provider Demographics
NPI:1992063812
Name:GRAY, SAMUEL III (MD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:GRAY
Suffix:III
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 1:1009 WILKINS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1026
Mailing Address - Country:US
Mailing Address - Phone:412-681-1319
Mailing Address - Fax:
Practice Address - Street 1:1009 WILKINS HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1026
Practice Address - Country:US
Practice Address - Phone:412-681-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027719L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease