Provider Demographics
NPI:1164428306
Name:GORDON, STUART JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:JAY
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:443-352-3849
Mailing Address - Fax:443-660-8257
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 325
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:443-352-3849
Practice Address - Fax:443-660-8257
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0041763207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKX69FROtherBCBS
MDKX69FROtherBCBS