Provider Demographics
NPI:1730705476
Name:SIEK, GORDON CHARLES (PHD)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:CHARLES
Last Name:SIEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27 DRYDOCK AVE FLR 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2382
Mailing Address - Country:US
Mailing Address - Phone:857-523-0154
Mailing Address - Fax:
Practice Address - Street 1:27 DRYDOCK AVE FLR 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2382
Practice Address - Country:US
Practice Address - Phone:857-523-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician