Basic Information
| Provider Information | |||||||||
| NPI: | 1477653236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCRAY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7068 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863508 | ||||||||
| FaxNumber: | 7576860541 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 KINGSBOROUGH SQ | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479294 | ||||||||
| FaxNumber: | 7572139374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101247264 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 0101247264 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | OPTIMA | OTHER | PAR | 01 | VA | UNITED HEALTHCARE | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1477653236 | 05 | VA | MEDICAID | 410299 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | MEDCOST | OTHER | PAR | 01 | VA | BCBS | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | CORVEL | OTHER | PAR | 01 | VA | TRICARE | OTHER | PAR | 01 | VA | VHN | OTHER |