Provider Demographics
NPI:1760207088
Name:MACDONALD, GORDON
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 MORLEY RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8031
Mailing Address - Country:US
Mailing Address - Phone:216-469-5900
Mailing Address - Fax:
Practice Address - Street 1:7940 MORLEY RD
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44060-8031
Practice Address - Country:US
Practice Address - Phone:216-469-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty