MEDICARE: DR. DANIEL GORDON M.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
1	207R00000X	Internal Medicine Physician	D0055199	MD

General Provider Information

NPI Number	:	1821311192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL GORDON M.D.

Provider Business Mailing Address
First Line	:	3311 LABYRINTH RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-1729
Country	:	US
Telephone Number	:	443-929-6221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 LABYRINTH RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-1729
Country	:	US
Telephone Number	:	443-929-6221
Fax Number	:

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

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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