Provider Demographics
NPI:1588008916
Name:GORMAN, PRESTON GENE (PA)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:GENE
Last Name:GORMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 OAKLAWN DR STE A
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3339
Mailing Address - Country:US
Mailing Address - Phone:540-613-1825
Mailing Address - Fax:540-870-6133
Practice Address - Street 1:1043 OAKLAWN DR STE A
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3339
Practice Address - Country:US
Practice Address - Phone:540-613-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08373363A00000X
VA0110008225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant