Active NPI
Dante Lemar Gorham, PT
- Physical Therapist
- Bowie, MD
National Provider Identifier
1003077660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 22499
- Practice address
- 4000 Mitchellville Rd
Ste A400
Bowie, MD 20716-3104 - Phone
- (301) 805-7110
- NPI assigned
- Jun 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 22499 | MD | Primary |
Addresses
Primary practice location
4000 Mitchellville Rd
Ste A400
Bowie, MD 20716-3104
Mailing address
2021 Quebec St
Adelphi, MD 20783-2128
Phone (301) 434-3658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37122 | CA | MD | Pharmacist |
| 22499 | MD | MD | Physical Therapist |
Interoperability endpoints
- https://api.platform.athenahealth.com/9012/brand/1/csg/1/fhir/r4
- https://api.platform.athenahealth.com/15585/brand/3/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366243200000",
"number": "1003077660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2021 QUEBEC ST",
"city": "ADELPHI",
"state": "MD",
"postal_code": "207832128",
"telephone_number": "301-434-3658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 MITCHELLVILLE RD",
"address_2": "STE A400",
"city": "BOWIE",
"state": "MD",
"postal_code": "207163104",
"telephone_number": "301-805-7110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORHAM",
"first_name": "DANTE",
"middle_name": "LEMAR",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-17",
"last_updated": "2013-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "22499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.