Provider Demographics
NPI:1033175005
Name:OSTRUM, GORDON J JR (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:OSTRUM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-454-9800
Mailing Address - Fax:302-454-6446
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-454-9800
Practice Address - Fax:302-454-6446
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001861207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4288126OtherAETNA
DEE97888OtherBLUE CROSS BLUE SHIELD
DE304818OtherCOVENTRY
00083564000OtherAMERIHEALTH
DEE97888OtherBLUE CROSS BLUE SHIELD
NJ054344QCUMedicare ID - Type UnspecifiedMEDICARE-NEW JERSEY
E97888Medicare UPIN
DE000A32O08Medicare ID - Type UnspecifiedMEDICARE-DELAWARE