Provider Demographics
NPI:1811931876
Name:GORMAN, STEPHEN R (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 FODEN ROAD
Mailing Address - Street 2:WEST BUILDING SUITE 103
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-1122
Mailing Address - Fax:207-828-0188
Practice Address - Street 1:100 FODEN ROAD
Practice Address - Street 2:WEST BUILDING SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-828-1122
Practice Address - Fax:207-828-0188
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1717207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME283650099Medicaid
MEH67113Medicare UPIN
ME283650099Medicaid