Provider Demographics
NPI:1124068044
Name:GORDON, JEFFREY N (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:N
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 1:140 W GERMANTOWN PIKE
Mailing Address - Street 2:STE 250
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1421
Mailing Address - Country:US
Mailing Address - Phone:484-530-0205
Mailing Address - Fax:484-530-0209
Practice Address - Street 1:400 DAVIS DR STE 200B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1718
Practice Address - Country:US
Practice Address - Phone:215-242-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059491L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA769125Medicare PIN
F80217Medicare UPIN