MEDICARE: RICHARD D GORDON, M.D., P.A.

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	207RR0500X	Rheumatology Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548287568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD D GORDON, M.D., P.A.

Provider Business Mailing Address
First Line	:	2121 KLOCKNER RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-3417
Country	:	US
Telephone Number	:	609-587-9898
Fax Number	:	609-584-1774

Provider Business Practice Location Address
First Line	:	2121 KLOCKNER RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-3417
Country	:	US
Telephone Number	:	609-587-9898
Fax Number	:	609-584-1774

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JUDITH S GORDON
Credential	:
Telephone Number	:	609-587-9898

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	12/07/2009

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