Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 82013 | MA |
NPI | 1013925569 |
---|---|
Provider Name | Marcus T Gordon |
First Address | Lynn, MA 01904 |
Second Address | Lynn, MA 01904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |