Provider Demographics
NPI:1053480269
Name:GORDON, ANN MARIE DONNA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:DONNA
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:301-257-5033
Mailing Address - Fax:301-408-3204
Practice Address - Street 1:106 IRVING ST NW STE 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2993
Practice Address - Country:US
Practice Address - Phone:202-877-0400
Practice Address - Fax:202-877-0584
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD22148207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG98587Medicare UPIN
DC491173Medicare PIN