Provider Demographics
NPI:1972748549
Name:GORDON, JAMES SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SAMUEL
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 1:2934 MACOMB ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3315
Mailing Address - Country:US
Mailing Address - Phone:202-537-6837
Mailing Address - Fax:202-966-2589
Practice Address - Street 1:2934 MACOMB ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3315
Practice Address - Country:US
Practice Address - Phone:202-537-6837
Practice Address - Fax:202-966-2589
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC23171100000X
DCMD102662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No171100000XOther Service ProvidersAcupuncturist