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NPI Code Detail

MEDICARE: DR. NATHANIEL TUCAY GORDON M.D.

MEDICARE: DR. NATHANIEL TUCAY GORDON M.D.
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
1207RS0012XSleep Medicine (Internal Medicine) Physician1025754MA
2207QS1201XSleep Medicine (Family Medicine) Physician1025754MA
3207QS1201XSleep Medicine (Family Medicine) Physician0101262244VA

General Provider Information

NPI Number : 1700266988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHANIEL TUCAY GORDON M.D.
Provider Business Mailing Address
First Line : 855 W BRAMBLETON AVE
Second Line :
City : NORFOLK
State : VA
Zip : 23510-1005
Country : US
Telephone Number : 757-446-5906
Fax Number :
Provider Business Practice Location Address
First Line : 75 FRANCIS ST
Second Line :
City : BOSTON
State : MA
Zip : 02115-6110
Country : US
Telephone Number : 617-732-4013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2015
Last Update Date : 04/22/2026

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