Provider Demographics
NPI:1740277565
Name:GORNISIEWICZ, ELZBIETA E (MD)
Entity type:Individual
Prefix:DR
First Name:ELZBIETA
Middle Name:E
Last Name:GORNISIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-481-0333
Mailing Address - Fax:865-482-9614
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 300
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-481-0333
Practice Address - Fax:865-482-9614
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD365942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN130025933OtherRAILROAD MEDICARE
TN1740277565Medicaid
TN1740277565Medicaid
TN3877555Medicare PIN