Healthcare Provider Details

I. General information

NPI: 1659333946
Provider Name (Legal Business Name): DAVID A. GORELICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 NATHAN SHOCK DR
BALTIMORE MD
21224-6823
US

IV. Provider business mailing address

5500 NATHAN SHOCK DR
BALTIMORE MD
21224-6823
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-1478
  • Fax: 410-550-1528
Mailing address:
  • Phone: 410-550-1478
  • Fax: 410-550-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0038998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: