Healthcare Provider Details

I. General information

NPI: 1699196204
Provider Name (Legal Business Name): GORDON TAYLOR M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7123 162ND ST APT 1J
FRESH MEADOWS NY
11365-4395
US

IV. Provider business mailing address

5237 RIVER RD UNIT 201
BETHESDA MD
20816-1415
US

V. Phone/Fax

Practice location:
  • Phone: 202-270-8717
  • Fax:
Mailing address:
  • Phone: 202-270-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD007251
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD007251
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD77251
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101270838
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD043160
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0077251
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: