Provider Demographics
NPI:1548909500
Name:GORLESKI, ERNEST GLENN (NFP-BC)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:GLENN
Last Name:GORLESKI
Suffix:
Gender:M
Credentials:NFP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 EUGENE DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2331
Mailing Address - Country:US
Mailing Address - Phone:443-768-7378
Mailing Address - Fax:
Practice Address - Street 1:913 EUGENE DR
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2331
Practice Address - Country:US
Practice Address - Phone:443-768-7378
Practice Address - Fax:410-939-0072
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224004207Q00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine