Provider Demographics
NPI:1942287305
Name:GERALD GORDON, MD, FACP, LLC
Entity Type:Organization
Organization Name:GERALD GORDON, MD, FACP, LLC
Other - Org Name:INTERNAL MEDICINE ASSOCIATES OF AIKEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-649-5300
Mailing Address - Street 1:PO BOX 5238
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-5238
Mailing Address - Country:US
Mailing Address - Phone:803-649-5300
Mailing Address - Fax:803-649-0056
Practice Address - Street 1:102 SUMMERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7704
Practice Address - Country:US
Practice Address - Phone:803-649-5300
Practice Address - Fax:803-649-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17475207R00000X
SC21255207R00000X
SC0689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2024Medicaid
SCCG6336OtherRAILROAD MEDICARE
SCGP2024Medicaid