Provider Demographics
NPI:1669557526
Name:GORDON, JOHN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6830 HOSPITAL DRIVE #202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4377
Mailing Address - Country:US
Mailing Address - Phone:410-575-0077
Mailing Address - Fax:410-574-0884
Practice Address - Street 1:6830 HOSPITAL DRIVE #202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4377
Practice Address - Country:US
Practice Address - Phone:410-575-0077
Practice Address - Fax:410-574-0884
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD14268207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76737Medicare UPIN
MD03716JC20Medicare ID - Type Unspecified388L
MD388LMedicare PIN