Healthcare Provider Details

I. General information

NPI: 1225021546
Provider Name (Legal Business Name): ROBERT GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 WASHINGTON RD SUITE 209
WESTMINSTER MD
21157-5750
US

IV. Provider business mailing address

826 WASHINGTON RD SUITE 209
WESTMINSTER MD
21157-5750
US

V. Phone/Fax

Practice location:
  • Phone: 410-840-8203
  • Fax: 410-751-2816
Mailing address:
  • Phone: 410-840-8203
  • Fax: 410-751-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD20554
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: