# GARY M GORDON DPM PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659455756
- **Authorized official:** GARY M GORDON DPM (PRESIDENT)
- **Authorized official phone:** (215) 887-5910

## Contact information

- **Practice address:** 2285 CROSS RD, GLENSIDE, PA 19038
- **Practice address phone:** (215) 887-5910
- **Practice address fax:** (215) 887-0387
- **Mailing address:** 2285 CROSS RD, GLENSIDE, PA 19038
- **Mailing address phone:** (215) 887-5910
- **Mailing address fax:** (215) 887-0387

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | SC00L57L | PA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | SC001507L | PA | — |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 03/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000118918 | PA BLUE SHIELD | — |
| 01 | — | 0060635000 | KEYSTONE | — |
| 01 | — | 1991 | AETNA HMO | — |
| 01 | — | 7305038 | AETNA | — |