Provider Demographics
NPI:1780734608
Name:GORDON, NEIL ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ALAN
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:539 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2216
Mailing Address - Country:US
Mailing Address - Phone:203-834-7700
Mailing Address - Fax:203-834-8877
Practice Address - Street 1:539 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2216
Practice Address - Country:US
Practice Address - Phone:203-834-7700
Practice Address - Fax:203-834-8877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035181207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG28230Medicare UPIN