Provider Demographics
NPI:1033165246
Name:GORMAN, RICHARD FORBES JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FORBES
Last Name:GORMAN
Suffix:JR
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:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-636-5135
Mailing Address - Fax:252-636-5395
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-636-5135
Practice Address - Fax:252-636-5395
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900232207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133V2OtherBCBS OF NC
NC89133V2Medicaid
NC133V2OtherBCBS OF NC
NCP00025120Medicare PIN
NC89133V2Medicaid