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NPI Code Detail

MEDICARE: DR. ANDREW HARRIS GORDON M.D., PH.D.

MEDICARE: DR. ANDREW HARRIS GORDON M.D., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician0101256842VA
22081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianMD042668DC
3208100000XPhysical Medicine & Rehabilitation PhysicianD0078288MD
42081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician0101256842VA
52081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianD0078288MD
6208100000XPhysical Medicine & Rehabilitation PhysicianMD042668DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013232628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW HARRIS GORDON M.D., PH.D.
Provider Business Mailing Address
First Line : 1776 WOODSTEAD CT STE 208
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-1480
Country : US
Telephone Number : 877-749-7428
Fax Number : 281-724-3100
Provider Business Practice Location Address
First Line : 1850 TOWN CENTER PKWY
Second Line :
City : RESTON
State : VA
Zip : 20190-3298
Country : US
Telephone Number : 703-949-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2010
Last Update Date : 05/26/2026

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