Provider Demographics
NPI:1245400332
Name:TIMOTHY L GORDON MD ORTHOPEDICS PA
Entity Type:Organization
Organization Name:TIMOTHY L GORDON MD ORTHOPEDICS PA
Other - Org Name:TOMOTHY L GORDON MD ORTHOPEDICS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LIVINGSTON
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-954-3225
Mailing Address - Street 1:34950 CHARDON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9162
Mailing Address - Country:US
Mailing Address - Phone:440-954-3225
Mailing Address - Fax:440-954-3226
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-954-3225
Practice Address - Fax:440-954-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0839221Medicaid
OH0839221Medicaid
OH9330301Medicare PIN