Individual
BERNARD J. GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
145 NEWBURY ST, PORTLAND, ME 04101-4261
(207) 772-5400
(207) 772-5402
Mailing address
145 NEWBURY ST, PORTLAND, ME 04101-4261
(207) 772-5400
(207) 772-5402
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD11839
ME
2084P0804X
Child & Adolescent Psychiatry Physician
MD11839
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022314
ANTHEM BLUE CROSS
ME
Enumeration date
08/18/2006
Last updated
07/13/2015
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