1982639043 NPI number — DR. CHRISTOPHER DAVID GORDON MD

Table of content: DR. CHRISTOPHER DAVID GORDON MD (NPI 1982639043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982639043 NPI number — DR. CHRISTOPHER DAVID GORDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982639043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CLARKS HL
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-8172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-628-6652
Provider Business Mailing Address Fax Number:
508-861-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1881 WORCESTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-628-6652
Provider Business Practice Location Address Fax Number:
508-861-0933
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  40833 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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