Basic Information
| Provider Information | |||||||||
| NPI: | 1740914738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | TERRANCE | ||||||||
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| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SUPERIOR AVE E | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441142614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162208774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29201 AURORA RD # 400 | ||||||||
| Address2: | |||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441391846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005772054 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2022 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | APS.003355 | OH | Y | Nursing Service Related Providers | Technician |
No ID Information.