Provider Demographics
NPI:1275714222
Name:GORDON, BECKY J (MD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2050
Mailing Address - Fax:717-812-2052
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-2050
Practice Address - Fax:717-812-2052
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP009309OtherGATEWAY-WMG
PA209954OtherJOHNS HOPKINS
PA2038828OtherHIGHMARK BLUE SHIELD
PA929805-01OtherCAREFIRST MD BCBS
PA9763177OtherAETNA
PA102125740Medicaid
PA20077599OtherAMERIHEALTH MERCY-WMG
PA239924OtherUNISON-WMG
PA50077636OtherCAPITAL BLUE CROSS-WMG
PA119586OtherGEISINGER HEALTH PLAN
PA209954OtherJOHNS HOPKINS
PA20077599OtherAMERIHEALTH MERCY-WMG
PA126110-FLTMedicare PIN