Healthcare Provider Details

I. General information

NPI: 1053608802
Provider Name (Legal Business Name): GORDON PHILIP SALGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 MITSCHER AVE
NORFOLK VA
23551-1044
US

IV. Provider business mailing address

1562 MITSCHER AVE
NORFOLK VA
23551-2421
US

V. Phone/Fax

Practice location:
  • Phone: 578-363-6447
  • Fax:
Mailing address:
  • Phone: 757-836-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60410629
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: