MEDICARE: GORDON N SHECKET 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	207ZN0500X	Neuropathology Physician	35040207	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35040207	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	220023091	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396747036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON N SHECKET MD

Provider Business Mailing Address
First Line	:	501 GREENGLADE AVE
Second Line	:	CORPATH-CRED
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2291
Country	:	US
Telephone Number	:	614-436-6436
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 GREENGLADE AVE
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2291
Country	:	US
Telephone Number	:	614-436-6436
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/29/2016

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