MEDICARE: JEFF GORDON MBA

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	101YP2500X	Professional Counselor		MD

General Provider Information

NPI Number	:	1093652067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF GORDON MBA

Provider Business Mailing Address
First Line	:	4301 GARDEN CITY DR STE 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-6102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 GARDEN CITY DR STE 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-6102
Country	:	US
Telephone Number	:	443-839-0012
Fax Number	:

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

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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Directions to “ JEFF GORDON MBA” Practice Location

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