Provider Demographics
NPI:1407811334
Name:GORDON, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2121
Mailing Address - Country:US
Mailing Address - Phone:978-304-8451
Mailing Address - Fax:978-304-8449
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-304-8451
Practice Address - Fax:978-304-8449
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54391207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2384OtherFALLON
MA3300086OtherUNITED HEALTHCARE
MA5161OtherHARVARD PILGRIM
MA710566OtherTUFTS
MA91531OtherCIGNA
MA28480OtherMATTHEW THORNTON
MA28480OtherANTHEM
MA3023397Medicaid
MAJ06385OtherBCBS
MA710566OtherTUFTS
MA1407811334Medicare NSC