Provider Demographics
NPI:1245804574
Name:GORDON, DOMONICK KARL ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMONICK
Middle Name:KARL ANDRE
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOWARD UNIVERSITY HOSPITAL, 2041 GEORGIA AVENUE, NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-4833
Mailing Address - Fax:
Practice Address - Street 1:HOWARD UNIVERSITY HOSPITAL, 2041 GEORGIA AVENUE, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program