Gordon, Jonathan K

Gordon, Jonathan K is an sole proprietor health care provider with primary practice located at 100 Amesbury St Suite 113, Lawrence MA 01840-1321. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Gordon, Jonathan K can be contacted via phone (978) 685-5474.

Contact Information

Primary practice address
100 Amesbury St Suite 113 Lawrence MA 01840-1321
Phone: (978) 685-5474
Fax: (978) 689-0493
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 79322 Massachusetts
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 79322 Massachusetts

Profile Details

NPI number 1568460483
LBN Legal business name Gordon, Jonathan K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 13th, 2005
Last updated Mar 4th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568460483 NPPES
Massachusetts MEDICAID 3188396

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