Provider Demographics
NPI:1720081920
Name:ZORN, GUNNAR WALFRID III (MD)
Entity Type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:WALFRID
Last Name:ZORN
Suffix:III
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 1:614 EASTERN SHORE DR STE C
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5940
Mailing Address - Country:US
Mailing Address - Phone:443-260-2660
Mailing Address - Fax:443-260-2754
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:#400
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42913208100000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754561400Medicaid
MDBZ2019948OtherDEA
MDLC39Medicare PIN
MDBZ2019948OtherDEA