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General NPI Number Information
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NPI Number | 1063636041
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Entity Type | Individual
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Provider Name | MARY ELIZABETH GORMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1005 HEALTH CENTER DR STE 201
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City | MATTOON
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State | IL
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Zip | 61938-4653
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Country | US
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Telephone | 217-258-2409
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Fax | 217-258-2323
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Provider Business Mailing Address
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Address Line | PO BOX 372
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City | MATTOON
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State | IL
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Zip | 61938-0372
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036175158
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D69143
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License Number State | MD
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