Provider Demographics
NPI:1295718252
Name:GORDON, RAM Y (MD)
Entity type:Individual
Prefix:
First Name:RAM
Middle Name:Y
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 1:1305 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-292-2000
Practice Address - Fax:203-255-5212
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072186L207RC0000X
CT050491207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherRAILROAD MEDICARE TPI GROUP
PA1007278000OtherMEDICAID TPI GROUP
PA1014582330001Medicaid
PA597586OtherMEDICARE GROUP TPI
PA597586OtherMEDICARE GROUP TPI
PACD4829OtherRAILROAD MEDICARE TPI GROUP