Healthcare Provider Details

I. General information

NPI: 1700266988
Provider Name (Legal Business Name): NATHANIEL TUCAY GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

855 W BRAMBLETON AVE
NORFOLK VA
23510-1005
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-4013
  • Fax:
Mailing address:
  • Phone: 757-446-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number1025754
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number1025754
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0101262244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: