Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0201X | Pediatric Allergist | C1-0012218 | DE |
Y | 2080P0201X | Pediatric Allergist | MD454558 | PA |
NPI | 1851667752 |
---|---|
Provider Name | Hillary Gordon |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Philadelphia, PA 19107-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | DE |
PENDING | (05) | PA |