Individual
STACY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA, PHILADELPHIA, PA 19104-4319
(215) 590-1944
(215) 590-4454
Mailing address
100 E PENN SQ, 9TH FLOOR NORTH TOWER, PHILADELPHIA, PA 19107-3323
(267) 425-9234
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD071070L
PA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
MD071070L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001803790
—
PA
Enumeration date
08/29/2006
Last updated
04/03/2014
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