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NPI Code Detail

MEDICARE: ALICIA GORDON

MEDICARE: ALICIA 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
1363AS0400XSurgical Physician Assistant
2363A00000XPhysician Assistant50.006208RXOH

General Provider Information

NPI Number : 1508490079
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA GORDON
Provider Business Mailing Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-444-3635
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-1078
Country : US
Telephone Number : 216-442-2004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2020
Last Update Date : 03/19/2024

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Directions to “ ALICIA GORDON ” Practice Location

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