Provider Demographics
NPI:1629496054
Name:GORDON, ANDREW JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 AVENT FERRY RD STE 214
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7776
Mailing Address - Country:US
Mailing Address - Phone:919-784-7874
Mailing Address - Fax:919-784-2708
Practice Address - Street 1:781 AVENT FERRY RD STE 214
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-784-7874
Practice Address - Fax:919-784-2708
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02426208600000X
VA0101266662208600000X
MA291190208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery