Gordon, Stacy

Gordon, Stacy is an individual health care provider with primary practice located at 3401 Civic Center Blvd Children'S Hospital Of Philadelphia, Philadelphia PA 19104-4319. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine is her primary health care specialty. Gordon, Stacy can be contacted via phone (215) 590-1944.

Contact Information

Primary practice address
3401 Civic Center Blvd Children'S Hospital Of Philadelphia Philadelphia PA 19104-4319
Phone: (215) 590-1944
Fax: (215) 590-4454
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD071070L Pennsylvania
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X MD071070L Pennsylvania

Profile Details

NPI number 1821106758
LBN Legal business name Gordon, Stacy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated Apr 3rd, 2014 - about 10 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 1821106758 NPPES
Pennsylvania MEDICAID 001803790

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