Healthcare Provider Details

I. General information

NPI: 1174526552
Provider Name (Legal Business Name): TIMOTHY E GORMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PLEASANT ST STE 5
CONCORD NH
03301-2952
US

IV. Provider business mailing address

50 HUTCHINS HILL RD
HOPKINTON NH
03229-2619
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-5220
  • Fax: 603-224-3336
Mailing address:
  • Phone: 603-224-5220
  • Fax: 603-224-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number11500
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: