Provider Demographics
NPI:1407819642
Name:GORDON, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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 1:1447 YORK RD
Mailing Address - Street 2:STE 406
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6057
Mailing Address - Country:US
Mailing Address - Phone:410-343-3001
Mailing Address - Fax:410-823-0015
Practice Address - Street 1:1447 YORK RD STE 406
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-343-3001
Practice Address - Fax:410-823-0015
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59060208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012931300005Medicaid
MD512707600Medicaid
MD731LD825Medicare PIN
PA438987Medicare PIN
MDF06337Medicare UPIN