Provider Demographics
NPI:1669463097
Name:GORDON, PAMELA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:G
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1113
Mailing Address - Country:US
Mailing Address - Phone:781-293-3838
Mailing Address - Fax:781-293-3639
Practice Address - Street 1:430 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1113
Practice Address - Country:US
Practice Address - Phone:781-293-3838
Practice Address - Fax:781-293-3639
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059450AMedicaid
MAJ1495201Medicare PIN
MA110059450AMedicaid