Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D30349 | MD |
NPI | 1073580254 |
---|---|
Provider Name | Dr. Richard L. Gorman |
First Address | Ellicott City, MD 21042-4024 |
Second Address | Ellicott City, MD 21042-4024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BG0822317 | DEA (01) | MD |
D32575 | (02) | MD |
M20198 | CDS (01) | MD |