Provider Demographics
NPI:1013572981
Name:GORDON, ANGELLICA O (MD)
Entity Type:Individual
Prefix:
First Name:ANGELLICA
Middle Name:O
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 MAGAZINE ST
Mailing Address - Street 2:APT B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4238
Mailing Address - Country:US
Mailing Address - Phone:810-618-3034
Mailing Address - Fax:
Practice Address - Street 1:433 BOLIVAR ST APT B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-7021
Practice Address - Country:US
Practice Address - Phone:810-618-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program