Provider Demographics
NPI:1073580254
Name:GORMAN, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9011 CHEVROLET DR
Mailing Address - Street 2:SUITE 7&8
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4024
Mailing Address - Country:US
Mailing Address - Phone:410-465-4111
Mailing Address - Fax:410-465-4124
Practice Address - Street 1:9011 CHEVROLET DR
Practice Address - Street 2:SUITE 7&8
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4024
Practice Address - Country:US
Practice Address - Phone:410-465-4111
Practice Address - Fax:410-465-4124
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD303492080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM20198OtherCDS
MDBG0822317OtherDEA
MDBG0822317OtherDEA