Individual
ANDREA E GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
195 CANAL ST, MALDEN, MA 02148-6701
(781) 338-0500
Mailing address
195 CANAL ST, MALDEN, MA 02148-6701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
223312
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1211382
—
MA
Enumeration date
10/18/2005
Last updated
11/29/2011
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