Provider Demographics
NPI:1740884634
Name:PAN, GORDON (ATC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KING HENRY DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2854
Mailing Address - Country:US
Mailing Address - Phone:603-275-4310
Mailing Address - Fax:
Practice Address - Street 1:13 KING HENRY DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-2854
Practice Address - Country:US
Practice Address - Phone:603-275-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer