Provider Demographics
NPI:1952583932
Name:GORDON, CHAD R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:R
Last Name:GORDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N. CAROLINE STREET, JHOC #8152F
Mailing Address - Street 2:DEPARTMENT OF PLASTIC SURGERY, JOHNS HOPKINS UNIVERSITY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:443-287-6425
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PLASTIC SURGERY JOHNS HOPKINS
Practice Address - Street 2:JHOC #8152F, 601 N. CAROLINE STREET
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:443-287-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242456208200000X
MDH72202208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52189Medicaid
NJMB07654400OtherNEW JERSEY LICENSE NUMBER
MA242456OtherMASSACHUSETTS STATE LICENSE