Provider Demographics
NPI:1871081414
Name:GRAY, SIMON MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:MATTHEW
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 STAGS HEAD RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1460
Mailing Address - Country:US
Mailing Address - Phone:443-794-8482
Mailing Address - Fax:
Practice Address - Street 1:AMBULATORY CARE CENTER 102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-966-1459
Practice Address - Fax:919-843-2356
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238237390200000X
NC2021-03123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty