Provider Demographics
NPI:1831079037
Name:JACOB L GORDON MD MS LLC
Entity type:Organization
Organization Name:JACOB L GORDON MD MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-524-0965
Mailing Address - Street 1:3120 MARNAT RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4503
Mailing Address - Country:US
Mailing Address - Phone:443-524-0965
Mailing Address - Fax:410-826-3780
Practice Address - Street 1:10 CROSSROADS DR STE 106
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5464
Practice Address - Country:US
Practice Address - Phone:443-524-0965
Practice Address - Fax:410-826-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty