Provider Demographics
NPI:1649279217
Name:FESSLER, GORDON STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:STEVEN
Last Name:FESSLER
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:PO BOX 637910
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7910
Mailing Address - Country:US
Mailing Address - Phone:513-853-4706
Mailing Address - Fax:513-853-4743
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4463
Practice Address - Country:US
Practice Address - Phone:513-794-5600
Practice Address - Fax:513-281-1908
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036655207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64789738Medicaid
IN100093660Medicaid
INP00675348OtherRAILROAD MEDICARE
OH0274617Medicaid
OH100003220OtherRAILROAD MEDICARE
IN172430BMedicare PIN
OHB29226Medicare UPIN
OH100003220OtherRAILROAD MEDICARE