Provider Demographics
NPI:1073947032
Name:GATES, TOM DENNIS II (CRNP-PMH)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:DENNIS
Last Name:GATES
Suffix:II
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 REISTERSTOWN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4342
Mailing Address - Country:US
Mailing Address - Phone:301-955-9812
Mailing Address - Fax:301-955-9813
Practice Address - Street 1:1515 REISTERSTOWN RD STE 201
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4342
Practice Address - Country:US
Practice Address - Phone:301-955-9812
Practice Address - Fax:301-955-9813
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207808363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health