Provider Demographics
NPI:1861221426
Name:GRAY, HERBERT LORENZA III
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:LORENZA
Last Name:GRAY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-6058
Mailing Address - Country:US
Mailing Address - Phone:804-306-7468
Mailing Address - Fax:
Practice Address - Street 1:1410 WALLACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-6058
Practice Address - Country:US
Practice Address - Phone:804-306-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide