Healthcare Provider Details

I. General information

NPI: 1235590357
Provider Name (Legal Business Name): DAVID A GORDON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK RD SUITE 406
LUTHERVILLE MD
21093-6017
US

IV. Provider business mailing address

1447 YORK RD STE 406
LUTHERVILLE MD
21093-6057
US

V. Phone/Fax

Practice location:
  • Phone: 410-343-3001
  • Fax: 410-823-0015
Mailing address:
  • Phone: 410-343-3001
  • Fax: 410-823-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY MCCARTIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-343-3001