Individual
STEFANIE B GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
822 PINE ST STE 4B, PHILADELPHIA, PA 19107-6187
(215) 829-8110
(215) 829-8119
Mailing address
351 MILL RD, HAVERTOWN, PA 19083-3725
(610) 368-4387
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA054525
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134439037
—
PA
Enumeration date
09/03/2010
Last updated
04/05/2023
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