Provider Demographics
NPI:1518281237
Name:WILLIAM A GORMLEY, DPM, LLC
Entity Type:Organization
Organization Name:WILLIAM A GORMLEY, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-517-3171
Mailing Address - Street 1:1121 ANNAPOLIS ROAD
Mailing Address - Street 2:PMB #164
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1633
Mailing Address - Country:US
Mailing Address - Phone:443-517-3171
Mailing Address - Fax:410-305-4668
Practice Address - Street 1:1071 STATE ROUTE 3 N STE 203
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1784
Practice Address - Country:US
Practice Address - Phone:443-292-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01432213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty