Healthcare Provider Details

I. General information

NPI: 1255266086
Provider Name (Legal Business Name): MOSHE DORFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S FREDERICK AVE STE 110
GAITHERSBURG MD
20877-4151
US

IV. Provider business mailing address

37 PENNY LN
BALTIMORE MD
21209-2726
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-2273
  • Fax:
Mailing address:
  • Phone: 202-808-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR253296
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: