Provider Demographics
NPI:1073939971
Name:GORDY, DEBRA FISHER (RDMS, RVT, ARRT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:FISHER
Last Name:GORDY
Suffix:
Gender:F
Credentials:RDMS, RVT, ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-0208
Mailing Address - Country:US
Mailing Address - Phone:443-359-1382
Mailing Address - Fax:
Practice Address - Street 1:18667 LITTLE LN
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-4000
Practice Address - Country:US
Practice Address - Phone:443-359-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1881832471C3402X
MD355282471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography