Provider Demographics
NPI:1437208295
Name:MORGAN, GORDON T
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:T
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5301
Mailing Address - Country:US
Mailing Address - Phone:724-837-1133
Mailing Address - Fax:724-837-1133
Practice Address - Street 1:1007 BROAD ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5301
Practice Address - Country:US
Practice Address - Phone:724-837-1133
Practice Address - Fax:724-837-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02571237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMO213696OtherPENNSYLVAINIA BLUE SHIELD