MEDICARE: DR. SUSAN MASTER GORDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25MA08373200	NJ
2	207W00000X	Ophthalmology Physician	MD441470	PA

General Provider Information

NPI Number	:	1003034034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MASTER GORDON M.D.

Provider Business Mailing Address
First Line	:	1140 WHITE HORSE RD
Second Line	:	SUITE1
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2106
Country	:	US
Telephone Number	:	856-784-3366
Fax Number	:	856-784-4388

Provider Business Practice Location Address
First Line	:	1140 WHITE HORSE RD
Second Line	:	SUITE1
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2106
Country	:	US
Telephone Number	:	856-784-3366
Fax Number	:	856-784-4388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	10/24/2017

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