Individual
GREGORY A GORDON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
133 BROOKLINE AVE, INTERNAL MEDICINE, BOSTON, MA 02215-3904
(617) 421-8843
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
(617) 421-3487
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
226580
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2113210
—
MA
01
—
494375
TUFTS
MA
01
—
AA46469
HARVARD PILGRIM
MA
01
—
J29568
BLUE CROSS
MA
Enumeration date
02/21/2006
Last updated
07/08/2007
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