Healthcare Provider Details

I. General information

NPI: 1588683825
Provider Name (Legal Business Name): GREGORY HARRON GORMAN MD, M.H.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE BUILDING 10
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE BUILDING 10
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8462
  • Fax: 310-295-6173
Mailing address:
  • Phone: 301-319-8462
  • Fax: 310-295-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number036-164006
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number99-00058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: