Basic Information
| Provider Information | |||||||||
| NPI: | 1649279217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FESSLER | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 637910 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452637910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534706 | ||||||||
| FaxNumber: | 5138534743 | ||||||||
| Practice Location | |||||||||
| Address1: | 10600 MONTGOMERY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137945600 | ||||||||
| FaxNumber: | 5132811908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 35036655 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 64789738 | 05 | KY | MEDICAID | 100093660 | 05 | IN | MEDICAID | P00675348 | 01 | IN | RAILROAD MEDICARE | OTHER | 0274617 | 05 | OH | MEDICAID | 100003220 | 01 | OH | RAILROAD MEDICARE | OTHER |