Provider Demographics
NPI:1912921966
Name:GORDON, LISA GREEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GREEN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:GREEN-PADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:219 W. PATRICK STREET, SUITE 100
Mailing Address - Street 2:BEHAVIORAL HEALTH PARTNERS, INC.
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-662-3223
Mailing Address - Fax:301-662-7921
Practice Address - Street 1:219 W. PATRICK STREET, SUITE 100
Practice Address - Street 2:BEHAVIORAL HEALTH PARTNERS, INC.
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:301-662-3223
Practice Address - Fax:301-662-7921
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00535372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211004100Medicaid
MDF73405Medicare UPIN