1245831890 NPI number — PIERRE S GORDON MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245831890 NPI number — PIERRE S GORDON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIERRE S GORDON MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1245831890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 93RD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-543-0046
Provider Business Mailing Address Fax Number:
301-747-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 FRIENDSHIP BLVD STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-7256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-543-0046
Provider Business Practice Location Address Fax Number:
301-747-4750
Provider Enumeration Date:
11/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TALEBIAN
Authorized Official First Name:
SUSANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CBO MGR
Authorized Official Telephone Number:
703-955-4923

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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