Provider Demographics
NPI:1326017302
Name:GORDON, STEVEN ADAM (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ADAM
Last Name:GORDON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577A SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-368-7166
Mailing Address - Fax:703-368-5103
Practice Address - Street 1:8577 SUDLEY RD STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3860
Practice Address - Country:US
Practice Address - Phone:703-368-7166
Practice Address - Fax:703-368-5103
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000879213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
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0442570002OtherDMERC
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