Provider Demographics
NPI:1962482554
Name:GORDON, NINA J (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:J
Other - Last Name:ABRAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10715 DOWNSVILLE PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7240
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:11116 MEDICAL CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6710
Practice Address - Country:US
Practice Address - Phone:301-739-6144
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00577692085R0202X
MDD57769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD692303801Medicaid
DC016621R04Medicare PIN
VAP00340129Medicare PIN
DCP00210357Medicare PIN
MD221LK883Medicare PIN
VA00X011N04Medicare PIN