Basic Information
| Provider Information | |||||||||
| NPI: | 1831180215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD053052L | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 143050 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 2191573 | 01 | PA | UNITED HEALTH CARE (MAMSI) | OTHER | BG4194988 | 01 | PA | DEA | OTHER | 4549904 | 01 | PA | AETNA NON-HMO | OTHER | P00841788 | 01 | PA | RAILROAD MEDICARE | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 6121247 | 01 | PA | AETNA HMO | OTHER | 0014851760005 | 05 | PA | MEDICAID | 2191573 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | MD053052L | 01 | PA | LICENSE | OTHER |