Provider Demographics
NPI:1578652285
Name:GORDON, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1429 COBBLE SCOTT WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2262
Mailing Address - Country:US
Mailing Address - Phone:757-546-7778
Mailing Address - Fax:
Practice Address - Street 1:880 KEMPSVILLE RD STE 2500
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3990
Practice Address - Country:US
Practice Address - Phone:757-461-0050
Practice Address - Fax:757-461-4538
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101221420207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11001Medicare UPIN
VA00W009E02Medicare PIN
VAC09141Medicare PIN