Provider Demographics
NPI:1730382425
Name:RAY, GREGORY THOMAS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:RAY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7308
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0308
Mailing Address - Country:US
Mailing Address - Phone:800-292-1387
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:502-456-7075
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251434207ZP0102X, 207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421267300Medicaid
VA1730382425Medicaid
MD1022-0012OtherCAREFIRST BC/BS
DC051285400Medicaid
VA1730382425Medicaid