Healthcare Provider Details

I. General information

NPI: 1013111988
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PURPLE HEART AVE
DOVER AIR FORCE BASE DE
19902-5051
US

IV. Provider business mailing address

115 PURPLE HEART AVE
DOVER AIR FORCE BASE DE
19902-5051
US

V. Phone/Fax

Practice location:
  • Phone: 302-346-8716
  • Fax:
Mailing address:
  • Phone: 302-346-8716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number2008-01946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: