Provider Demographics
NPI:1053367151
Name:PRAY, CLYDE W (MD)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:W
Last Name:PRAY
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 1:13517 HUNTING HILL WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 RESEARCH BLVD
Practice Address - Street 2:350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3164
Practice Address - Country:US
Practice Address - Phone:301-838-9606
Practice Address - Fax:301-838-9029
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38116207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530561600Medicaid
601285800OtherFECA
MD530561600Medicaid
601285800OtherFECA
MD839M509FMedicare ID - Type UnspecifiedGROUP 839M