Healthcare Provider Details

I. General information

NPI: 1790903631
Provider Name (Legal Business Name): JOHN C GORDON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 HOSPITAL DR SUITE 202
BALTIMORE MD
21237-4373
US

IV. Provider business mailing address

6830 HOSPITAL DR SUITE 202
BALTIMORE MD
21237-4373
US

V. Phone/Fax

Practice location:
  • Phone: 301-574-0077
  • Fax: 301-574-0884
Mailing address:
  • Phone: 301-574-0077
  • Fax: 301-574-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNINE WILLS
Title or Position: MANAGER
Credential:
Phone: 410-574-0077