Healthcare Provider Details

I. General information

NPI: 1184379828
Provider Name (Legal Business Name): SAMANTHA KELLY GORDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005 BOX 110185
FPO AL
34009
US

IV. Provider business mailing address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005 BOX 110185
FPO AL
34009
US

V. Phone/Fax

Practice location:
  • Phone: 757-458-2998
  • Fax:
Mailing address:
  • Phone: 757-458-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208040
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102208040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: