Provider Demographics
NPI:1942275441
Name:GORMAN, TIMOTHY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:GORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E MAIN ST
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1121
Mailing Address - Country:US
Mailing Address - Phone:716-326-4678
Mailing Address - Fax:716-326-4914
Practice Address - Street 1:138 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1121
Practice Address - Country:US
Practice Address - Phone:716-326-4678
Practice Address - Fax:716-326-4914
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01032475Medicaid
NYB82967Medicare UPIN
NY01032475Medicaid