Provider Demographics
NPI:1548266257
Name:GORDON, PATRICIA L (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:800-243-1455
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:MC A410
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8414
Practice Address - Fax:717-531-0221
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424782207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015566460001Medicaid
TN3898262Medicaid