Provider Demographics
NPI:1841266814
Name:GORDON, RICHARD F (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:F
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5438
Mailing Address - Country:US
Mailing Address - Phone:302-366-7665
Mailing Address - Fax:302-366-0734
Practice Address - Street 1:3301 LANCASTER PIKE
Practice Address - Street 2:UNITS 3I AND 3J
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1436
Practice Address - Country:US
Practice Address - Phone:302-366-7665
Practice Address - Fax:302-366-0734
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10000786207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000091001Medicaid
D01152Medicare UPIN
DE0000091001Medicaid