Individual
CHARLES FOX GORDON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 OLD PLANK ROAD, SUITE 100, CLIFTON PARK, NY 12065-3107
(518) 371-0777
(518) 371-0366
Mailing address
9 OLD PLANK RD STE 100, CLIFTON PARK, NY 12065-3107
(518) 371-0777
(518) 371-0366
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
1889491
NY
208VP0014X
Interventional Pain Medicine Physician
Primary
1889491
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000405090003
BSNENY PIN - SPECIALIST
NY
05
—
01339826
—
NY
05
—
1339826
—
NY
Enumeration date
02/08/2006
Last updated
04/19/2023
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