Provider Demographics
NPI:1093239360
Name:MICHAEL S. GORDON M.D.
Entity Type:Organization
Organization Name:MICHAEL S. GORDON M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-257-1025
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4065
Mailing Address - Country:US
Mailing Address - Phone:978-304-8451
Mailing Address - Fax:978-304-8449
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4065
Practice Address - Country:US
Practice Address - Phone:978-304-8451
Practice Address - Fax:978-304-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54391207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty