MEDICARE: MARILYN B GORDON, MD PC

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	208000000X	Pediatrics Physician	81230	MA
2	207R00000X	Internal Medicine Physician	81230	MA

General Provider Information

NPI Number	:	1154541803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARILYN B GORDON, MD PC

Provider Business Mailing Address
First Line	:	107A COUNTY RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-5522
Fax Number	:	508-564-5544

Provider Business Practice Location Address
First Line	:	107A COUNTY RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-5522
Fax Number	:	508-564-5544

Authorized Official
Title or Position	:	OWNER
Name	:	MARILYN B GORDON
Credential	:	MD
Telephone Number	:	508-564-5522

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	03/15/2010

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