Provider Demographics
NPI:1801889944
Name:GORDON, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1493 WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1945
Mailing Address - Country:US
Mailing Address - Phone:610-391-1178
Mailing Address - Fax:610-391-9122
Practice Address - Street 1:1493 WETHERSFIELD DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1945
Practice Address - Country:US
Practice Address - Phone:610-391-1178
Practice Address - Fax:610-391-9122
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042046E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011442100007Medicaid
PA0011442100008Medicaid
PA423121OtherHIGHMARK PIN
PA423121OtherHIGHMARK PIN
PA0011442100007Medicaid
PA0011442100008Medicaid