Provider Demographics
NPI:1417452020
Name:GORIE, HALEY MEDLEN (MD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MEDLEN
Last Name:GORIE
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 1:9605 DOLPHIN RUN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-2020
Mailing Address - Country:US
Mailing Address - Phone:256-656-0047
Mailing Address - Fax:
Practice Address - Street 1:77 NEALY AVE BLDG 257
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2005
Practice Address - Country:US
Practice Address - Phone:757-764-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101267209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program