Healthcare Provider Details

I. General information

NPI: 1811359979
Provider Name (Legal Business Name): CAROLINE GORN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL ST
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

301 SAINT PAUL ST
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0089312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: