Provider Demographics
NPI:1942254602
Name:GORDON, MARTHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8577 CORDES CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3317
Mailing Address - Country:US
Mailing Address - Phone:901-751-4430
Mailing Address - Fax:901-751-4210
Practice Address - Street 1:8577 CORDES CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3317
Practice Address - Country:US
Practice Address - Phone:901-751-4430
Practice Address - Fax:901-751-4210
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000191542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE57231Medicare UPIN
TN1942254602Medicare PIN