Provider Demographics
NPI:1447289798
Name:RAY, MARILYN JEANNE (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEANNE
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-1117
Mailing Address - Country:US
Mailing Address - Phone:603-558-1260
Mailing Address - Fax:603-287-8098
Practice Address - Street 1:448 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-4123
Practice Address - Country:US
Practice Address - Phone:603-558-1260
Practice Address - Fax:603-287-8098
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04253742085R0202X
NE199442085R0202X
CODR-351772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100178640BMedicaid
CO91351775Medicaid
KSA50235Medicare UPIN
CO91351775Medicaid
KS100178640BMedicaid