MEDICARE: ARTHUR ERWIN GORDON MD

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	207VG0400X	Gynecology Physician	MD 025617L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	160058909	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1075777	OTHER	PA	KMHP
2	0052699000	OTHER	PA	INDEPENDENCE BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	30038145	OTHER	PA	KMHP
6	0168893802	OTHER	PA	AMERICHOICE
7	2Y6155	OTHER	PA	HEALTH NET
8	5062	OTHER	PA	BRAVO HEALTH
9	0002101	OTHER	PA	AETNA HMO
10	4556714	OTHER	PA	AETNA PPO
11	0168893801	OTHER	PA	AMERICHOICE

General Provider Information

NPI Number	:	1063496636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR ERWIN GORDON MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-9010
Fax Number	:	215-226-8286

Provider Business Practice Location Address
First Line	:	9331 OLD BUSTLETON AVE
Second Line	:	SUITE 203
City	:	PHILA
State	:	PA
Zip	:	19115-4634
Country	:	US
Telephone Number	:	215-602-8900
Fax Number	:	215-602-8904

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/18/2011

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