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NPI Code Detail

MEDICARE: GAREY THOMAS GORDON

MEDICARE: GAREY THOMAS GORDON
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
1101YP1600XPastoral Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1194128892
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAREY THOMAS GORDON
Provider Business Mailing Address
First Line : 847 HR DR SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-6013
Country : US
Telephone Number : 240-318-6405
Fax Number :
Provider Business Practice Location Address
First Line : 3000 PENNSYLVANIA AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-3718
Country : US
Telephone Number : 202-581-0490
Fax Number : 202-581-0496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2014
Last Update Date : 07/13/2023

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