Individual
RYAN A GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
11 SOUTH RD STE 200, FARMINGTON, CT 06032-2483
(860) 284-9544
(860) 284-9548
Mailing address
11 SOUTH RD, FARMINGTON, CT 06032-2483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H0078514
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2035987
—
MA
Enumeration date
02/13/2006
Last updated
03/05/2020
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