Provider Demographics
NPI:1467481648
Name:GORDON, NORMAN MERVYN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:MERVYN
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 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BUILDING 11
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-431-1860
Mailing Address - Fax:401-435-0328
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING 11
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-431-1860
Practice Address - Fax:401-435-0328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI73432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI20655-8OtherBLUE CROSS BLUE SHIELD
RI0500232OtherUNITED HEALTHCARE
RI201764OtherBC/BS BLUE CHIP
RI9006527Medicaid
RI2505OtherNEIGHBORHOOD HEALTH
RIE27582Medicare UPIN