Provider Demographics
NPI:1548204464
Name:GORDON, GREGORY R (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:GORDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:STE 201
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-946-1500
Practice Address - Fax:215-946-3417
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD034025E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7241941OtherCIGNA PA
PA053505OtherHIGHMARK BLUE SHIELD
PA0010906390006Medicaid
PA0022624000OtherKEYSTONE IBC
PA4217615OtherAETNA
PA30165547OtherKEYSTONE FIRST
PAP01193810OtherRAILROAD MEDICARE
PA30165547OtherKEYSTONE FIRST
PA7241941OtherCIGNA PA