Provider Demographics
NPI:1285640441
Name:WRAY, MISTY LEE (MD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:WRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 SCIENCE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4330
Mailing Address - Country:US
Mailing Address - Phone:301-860-1090
Mailing Address - Fax:301-860-1095
Practice Address - Street 1:17001 SCIENCE DR STE 120
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4330
Practice Address - Country:US
Practice Address - Phone:301-860-1090
Practice Address - Fax:301-860-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247113207W00000X
MDD0040969207W00000X
WV33212207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD912500100Medicaid
MDKN35C253Medicare PIN
MD912500100Medicaid
MDE96647Medicare UPIN