Individual provider Active NPI

Maja Lisa Lundborg-Gray, MD

  • Emergency Medicine Physician
  • Watertown, NY
National Provider Identifier
1174594774
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
208695 Issued in NY
Practice address
830 Washington St
Watertown, NY 13601-4066
Phone
(315) 785-4100
Fax
(315) 786-4962
NPI assigned
Jan 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 208695 NY Primary

Addresses

Primary practice location

830 Washington St
Watertown, NY 13601-4066

Mailing address

1116 Arsenal St
Suite 504
Watertown, NY 13601
Phone (315) 782-2620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050621000738 NY Practitioner - Emergency Medicine 7911981154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York Medical College, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical CenterGroup PAC ID 8123914876, 157 clinicians

Practice addresses (Care Compare)

830 Washington St
Watertown, NY 13601-4034
Phone (315) 785-4000

Hospital & facility affiliations

  • Samaritan Medical Center Hospital, Watertown, NY, CCN 330157

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
208695NYMDEmergency Medicine Physician

Interoperability endpoints

  • Direct secure messaging: mgray1@hiemail.healtheconnections.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174594774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 ARSENAL ST",
            "address_2": "SUITE 504",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-782-2620",
            "fax_number": "315-788-4980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014066",
            "telephone_number": "315-785-4100",
            "fax_number": "315-786-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDBORG-GRAY",
        "first_name": "MAJA",
        "middle_name": "LISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "208695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.