Provider Demographics
NPI:1295334076
Name:GORDON, PAIGE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4275
Mailing Address - Country:US
Mailing Address - Phone:315-410-6400
Mailing Address - Fax:
Practice Address - Street 1:6846 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4275
Practice Address - Country:US
Practice Address - Phone:315-410-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2022-01-27
Deactivation Date:2020-10-22
Deactivation Code:
Reactivation Date:2022-01-27
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant