Healthcare Provider Details

I. General information

NPI: 1265895866
Provider Name (Legal Business Name): EMILY ANN GORMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANN HUFFMAN D.O.

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5414
  • Fax:
Mailing address:
  • Phone: 614-533-3649
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.013388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: