MEDICARE: DR. ROBERT H GORDON 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	02134E	PA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD021343E	PA

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	:	1710901673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT H GORDON MD

Provider Business Mailing Address
First Line	:	1425 HORSHAM ROAD
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1320
Country	:	US
Telephone Number	:	215-371-3682
Fax Number	:	215-371-3039

Provider Business Practice Location Address
First Line	:	1425 HORSHAM RD
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-1320
Country	:	US
Telephone Number	:	215-371-3682
Fax Number	:	215-371-3039

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	12/01/2010

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