Provider Demographics
NPI:1518957422
Name:RORDORF, GUY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:A
Last Name:RORDORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4484
Mailing Address - Fax:617-726-5043
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WAC 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-4484
Practice Address - Fax:617-726-5043
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA806892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA080689OtherTUFTS HEALTH PLAN
MAJ31165OtherBCBS MA
MA3137759Medicaid
MAJ31165Medicare PIN
G00648Medicare UPIN