Provider Demographics
NPI:1316341159
Name:GORDON, SANLARE (DO)
Entity type:Individual
Prefix:
First Name:SANLARE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:410-820-0038
Mailing Address - Fax:410-820-0039
Practice Address - Street 1:2041 GEORGIA AVE NW LABOR AND DELIVERY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-4060
Practice Address - Country:US
Practice Address - Phone:202-865-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1841207V00000X
KS05-47037207V00000X
MDH80277207V00000X
DCDO210012339207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
163226ZDWSMedicare PIN