Provider Demographics
NPI:1952485443
Name:GORDON, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 DANIEL WEBSTER HWY
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2748
Mailing Address - Country:US
Mailing Address - Phone:603-429-3155
Mailing Address - Fax:603-424-8693
Practice Address - Street 1:696 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2748
Practice Address - Country:US
Practice Address - Phone:603-429-3155
Practice Address - Fax:603-424-8693
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5691207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT9419Medicare ID - Type Unspecified