Healthcare Provider Details

I. General information

NPI: 1265361901
Provider Name (Legal Business Name): ERNEST GORLESKI A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S STOKES ST
HAVRE DE GRACE MD
21078-3324
US

IV. Provider business mailing address

913 EUGENE DR
HAVRE DE GRACE MD
21078-2331
US

V. Phone/Fax

Practice location:
  • Phone: 410-688-3792
  • Fax: 410-939-0072
Mailing address:
  • Phone: 410-688-3792
  • Fax: 410-939-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERNEST GLENN GORLESKI
Title or Position: PRESIDENT
Credential:
Phone: 410-688-3792