Provider Demographics
NPI:1093716896
Name:GORDON, KATHLEEN G (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:105 BENDING BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5904
Mailing Address - Country:US
Mailing Address - Phone:919-678-9987
Mailing Address - Fax:
Practice Address - Street 1:UNC CH DEPARTMENT OF OPHTHALMOLOGY
Practice Address - Street 2:130MASON FARM RD, 5151 BIOINFORMATICS
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7040
Practice Address - Country:US
Practice Address - Phone:919-966-5296
Practice Address - Fax:919-966-1908
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-12-09
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Provider Licenses
StateLicense IDTaxonomies
NC200301119207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5177534OtherAETNA
NC805415OtherPARTNERS
NC31770OtherOPTICARE
NC1366AOtherBCBS NC
NC2129642OtherMAMSI
NCD5541OtherMEDCOST
NC0800622OtherUNITED HEALTHCARE
NC891366AMedicaid
NC805415OtherPARTNERS
NC1366AOtherBCBS NC
NC2129642OtherMAMSI