# CHRISANNE GORDON, MD

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

## Provider details

- **NPI number:** 1962896969
- **Authorized official:** CHRISANNE GORDON MD (PHYSICIAN)
- **Authorized official phone:** (937) 578-2255

## Contact information

- **Practice address:** 500 LONDON AVENUE, MARYSVILLE, OH 43040
- **Practice address phone:** (937) 578-2255
- **Mailing address:** 6724 PERIMETER LOOP RD., PMB \#317, DUBLIN, OH 43017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | 35042915 | OH | Yes |

## Other

- **Enumeration date:** 03/27/2015
- **Last updated:** 03/27/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0707328 | — | OH |