Healthcare Provider Details

I. General information

NPI: 1548909500
Provider Name (Legal Business Name): ERNEST GLENN GORLESKI NFP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
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: 443-768-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR224004
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR224004
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: