MEDICARE: GORDON R DONALDSON DO

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	207Q00000X	Family Medicine Physician	OS006437L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080053959	OTHER	PA	TRAVELERS MEDICARE

General Provider Information

NPI Number	:	1942295027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON R DONALDSON DO

Provider Business Mailing Address
First Line	:	4103 MAIN ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9378
Country	:	US
Telephone Number	:	610-286-9064
Fax Number	:	610-286-7832

Provider Business Practice Location Address
First Line	:	4103 MAIN ST
Second Line	:
City	:	ELVERSON
State	:	PA
Zip	:	19520-9378
Country	:	US
Telephone Number	:	610-286-9064
Fax Number	:	610-286-7832

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	06/07/2024

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Practice Location Address:

4101 MAIN ST
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19520-9378

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1407902257 — MR. SCOTT W. WALLACE DDS
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1487935441 — JENNIFER S FRONDA PA
Practice Location Address:

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ELVERSON, PA
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1326600628 — DR. JOSEPH FUNARI DMD
Practice Location Address:

4101 MAIN ST
ELVERSON, PA
19520-9378

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1437156387 — GORDON RICHARD ECK D.O.
Practice Location Address:

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1013919661 — DOUGS FAMILY PHARMACY
Practice Location Address:

101 DARBY SQ
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Directions to “ GORDON R DONALDSON DO” Practice Location

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