Provider Demographics
NPI:1861774432
Name:GRAY, JOYCELYNN REVAE (DO)
Entity type:Individual
Prefix:DR
First Name:JOYCELYNN
Middle Name:REVAE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOYCELYNN
Other - Middle Name:REVAE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2409 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4321
Mailing Address - Country:US
Mailing Address - Phone:850-485-4585
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:443-444-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74691207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine