Individual
CARRIE A GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
887 CONGRESS ST., SUITE 320, PORTLAND, ME 04102
(207) 662-5522
(207) 662-5527
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 621-2000
(207) 661-2033
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD16227
ME
2080P0210X
Pediatric Nephrology Physician
Primary
MD16227
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30204313
—
NH
05
—
407810099
—
ME
Enumeration date
10/02/2006
Last updated
04/26/2017
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