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General NPI Number Information
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NPI Number | 1679235444
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Entity Type | Individual
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Provider Name | MR. CHRISTOPHER JAMES GORDON
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Gender | Male
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Dates
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Enumeration Date | 10/09/2021
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 301 SAINT PAUL ST
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City | BALTIMORE
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State | MD
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Zip | 21202-2165
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Country | US
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Telephone | 410-332-9717
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Fax |
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Provider Business Mailing Address
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Address Line | 50 ROCHESTER PL APT 22
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5547
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Country | US
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Telephone | 302-593-6491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C08507
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License Number State | MD
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