Healthcare Provider Details

I. General information

NPI: 1912921966
Provider Name (Legal Business Name): LISA GREEN GORDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA DAWN GREEN-PADEN MD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 7TH ST
CHAMBERSBURG PA
17201-1720
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7771
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0053537
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: