Provider Demographics
NPI:1063496636
Name:GORDON, ARTHUR ERWIN (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:ERWIN
Last Name:GORDON
Suffix:
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4634
Practice Address - Country:US
Practice Address - Phone:215-602-8900
Practice Address - Fax:215-602-8904
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 025617L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1075777OtherKMHP
PA0052699000OtherINDEPENDENCE BLUE CROSS
PA160058909OtherRR MEDICARE
PA001688938Medicaid
PA30038145OtherKMHP
PA0168893802OtherAMERICHOICE
PA2Y6155OtherHEALTH NET
PA5062OtherBRAVO HEALTH
PA0002101OtherAETNA HMO
PA4556714OtherAETNA PPO
PA0168893801OtherAMERICHOICE
PA0168893801OtherAMERICHOICE
PA160058909OtherRR MEDICARE