Provider Demographics
NPI:1952643652
Name:GORDON, ROBERT B
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 GRUBBS RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9422
Mailing Address - Country:US
Mailing Address - Phone:412-779-0696
Mailing Address - Fax:724-933-4095
Practice Address - Street 1:4552 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:866-677-7995
Practice Address - Fax:724-933-4095
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102563529Medicaid