MEDICARE: DR. STEPHEN GORMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	042-0006480	VT
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	042.0006480	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063426864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN GORMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1517
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-1517
Country	:	US
Telephone Number	:	802-382-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 PEARL ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3659
Country	:	US
Telephone Number	:	802-878-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/22/2020

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