Provider Demographics
NPI:1003121096
Name:GORMLEY, NICOLE JEANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JEANINE
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DR
Mailing Address - Street 2:BLDG 10, RM 2C145
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-496-9320
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BLDG 10, RM 2C145
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064507207RC0200X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology