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NPI Code Detail

MEDICARE: JENNIFER MARIE GORDON

MEDICARE:   JENNIFER MARIE GORDON
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1093969842
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE GORDON
Provider Business Mailing Address
First Line : 5420 KEEPORT DR APT 4
Second Line :
City : PITTSBURGH
State : PA
Zip : 15236-3047
Country : US
Telephone Number : 724-732-3828
Fax Number :
Provider Business Practice Location Address
First Line : 322 N SHORE DR STE 200
Second Line :
City : PITTSBURGH
State : PA
Zip : 15212-5875
Country : US
Telephone Number : 724-732-3828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2008
Last Update Date : 08/10/2020

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