Healthcare Provider Details

I. General information

NPI: 1598100307
Provider Name (Legal Business Name): KATHLEEN ANN GORMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 03/03/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY # A3
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

700 AMERICANA DR APT A3
ANNAPOLIS MD
21403-3344
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-6200
  • Fax:
Mailing address:
  • Phone: 443-850-4136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD044087
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0091382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: