David Wayne Gordon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810000716 Issued in VA

Practice address

1611 Colley Ave Ste D
Norfolk, VA 23517-1677

Phone

(757) 288-9741

Fax

(757) 625-2563

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396755617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 COLLEY AVE STE D",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171677",
            "telephone_number": "757-288-9741",
            "fax_number": "757-622-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 COLLEY AVE STE D",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171677",
            "telephone_number": "757-288-9741",
            "fax_number": "757-625-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DAVID",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810000716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00707452",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Goolsby
• Zoe A Goranson, LCSW
• Christine Gorcica, LPTA
• Gordon a.Ryan,MD PC
• Bonnie D Gordon-Rabinowitz, LCSW
• James M Gordon, MD
• Jason Gordon, M.D.
• Jennifer R Gordon
• Leanne C Gordon, NP
• Leonard B Gordon, IDC/SMDR

• Clinical Psychologist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.