Basic Information
| Provider Information | |||||||||
| NPI: | 1548204464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N OXFORD VALLEY RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | FAIRLESS HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159461500 | ||||||||
| FaxNumber: | 2159463417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD034025E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7241941 | 01 | PA | CIGNA PA | OTHER | 053505 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0010906390006 | 05 | PA | MEDICAID | 0022624000 | 01 | PA | KEYSTONE IBC | OTHER | 4217615 | 01 | PA | AETNA | OTHER | 30165547 | 01 | PA | KEYSTONE FIRST | OTHER | P01193810 | 01 | PA | RAILROAD MEDICARE | OTHER |