Provider Demographics
NPI:1942239496
Name:GRAY, WILLIAM CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARK
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1221 MERCANTILE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5374
Mailing Address - Country:US
Mailing Address - Phone:301-618-5500
Mailing Address - Fax:301-618-5901
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-5828
Practice Address - Fax:410-328-5827
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-06-09
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Provider Licenses
StateLicense IDTaxonomies
MDD17424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD914651200Medicaid