MEDICARE: MR. DANIEL DELANO GORDON SR.

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
1	251E00000X	Home Health Agency	10360501	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1013897016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL DELANO GORDON SR.

Provider Business Mailing Address
First Line	:	206 W STATE ST FL 2
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-3105
Country	:	US
Telephone Number	:	610-602-9703
Fax Number	:	610-602-9739

Provider Business Practice Location Address
First Line	:	206 W STATE ST FL 2
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-3105
Country	:	US
Telephone Number	:	610-602-9703
Fax Number	:	610-602-9739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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