Provider Demographics
NPI:1750324562
Name:GORRELL, LENITA NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LENITA
Middle Name:NAOMI
Last Name:GORRELL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7845 OAKWOOD ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4257
Mailing Address - Country:US
Mailing Address - Phone:410-768-8214
Mailing Address - Fax:410-768-8215
Practice Address - Street 1:7845 OAKWOOD ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4257
Practice Address - Country:US
Practice Address - Phone:410-768-8214
Practice Address - Fax:410-768-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-09-07
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Provider Licenses
StateLicense IDTaxonomies
MDD19537207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD783001700Medicaid
MD783001700Medicaid
MDB70144Medicare UPIN