Provider Demographics
NPI:1104876853
Name:GORDON, IAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:DAVID
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 HINSON FARM RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3415
Mailing Address - Country:US
Mailing Address - Phone:703-780-3223
Mailing Address - Fax:703-780-9408
Practice Address - Street 1:8109 HINSON FARM RD
Practice Address - Street 2:SUITE 501
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3415
Practice Address - Country:US
Practice Address - Phone:703-780-3223
Practice Address - Fax:703-780-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044678207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE37899Medicare UPIN
VA566144Medicare PIN