Provider Demographics
NPI:1063660009
Name:GORMAN, RYAN BRADLEY (VMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BRADLEY
Last Name:GORMAN
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-5213
Mailing Address - Country:US
Mailing Address - Phone:856-825-8935
Mailing Address - Fax:
Practice Address - Street 1:2430 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-5213
Practice Address - Country:US
Practice Address - Phone:856-825-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29VI00552000174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian