Provider Demographics
NPI:1639179732
Name:GORDON, MURIEL M (MD)
Entity type:Individual
Prefix:
First Name:MURIEL
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BATH RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3101
Mailing Address - Country:US
Mailing Address - Phone:215-785-9070
Mailing Address - Fax:215-785-9021
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-785-9070
Practice Address - Fax:215-785-9021
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047843L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001628878Medicaid
PA458247Medicare PIN
PAF47351Medicare UPIN