Provider Demographics
NPI:1093412181
Name:GORDON, JULIAN
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-3851
Mailing Address - Country:US
Mailing Address - Phone:540-877-4596
Mailing Address - Fax:540-358-8023
Practice Address - Street 1:155 SHERWOOD LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-3851
Practice Address - Country:US
Practice Address - Phone:540-877-4596
Practice Address - Fax:540-358-8023
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 1744R1102X, 251B00000X, 261QR1100X
VA0225237917251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch