Provider Demographics
NPI:1528810744
Name:GORDON, MEGHAN PAVELKA
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:PAVELKA
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PUREFOY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4853
Mailing Address - Country:US
Mailing Address - Phone:919-622-5675
Mailing Address - Fax:
Practice Address - Street 1:590 MANNING DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:984-974-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program