MEDICARE: DR. STEPHEN J GORDIN MD

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	MD016749E	PA
2	207R00000X	Internal Medicine Physician	25MA07094500	NJ
3	207R00000X	Internal Medicine Physician	C10005407	DE

General Provider Information

NPI Number	:	1821328527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN J GORDIN MD

Provider Business Mailing Address
First Line	:	2030 MOUNT VERNON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3236
Country	:	US
Telephone Number	:	856-952-0532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 MOUNT VERNON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3236
Country	:	US
Telephone Number	:	856-952-0532
Fax Number	:

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

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/04/2010

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