Provider Demographics
NPI:1124089016
Name:GORDINHO, JOSE JORGE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JORGE
Last Name:GORDINHO
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 1:2962 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-254-9022
Mailing Address - Fax:304-254-9024
Practice Address - Street 1:2962 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-254-9022
Practice Address - Fax:304-254-9024
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16005207RN0300X
VA0101043986207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000553723OtherBLUE CROSS BLUE SHIELD
PA513901OtherMEDICARE PART A
VA005807000Medicaid
VA282397OtherBLUE CROSS BLUE SHIELD
WV0072202000Medicaid
VA390000151Medicare ID - Type Unspecified
WV0072202000Medicaid
WV000553723OtherBLUE CROSS BLUE SHIELD
WV4067001Medicare PIN