Individual
MARILYN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
65 LIBBY ST, BROCKTON, MA 02302-2992
(508) 584-6060
(508) 584-4949
Mailing address
65 LIBBY ST, BROCKTON, MA 02302-2992
(508) 584-6060
(508) 584-4949
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
81230
MA
208000000X
Pediatrics Physician
Primary
81230
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3144500
—
MA
01
—
65042
HARVARD PILGRIM
MA
01
—
761592
TUFTS HEALTH
MA
Enumeration date
05/13/2006
Last updated
12/13/2024
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