Provider Demographics
NPI:1912921966
Name:GORDON, LISA GREEN (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GREEN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:DAWN
Other - Last Name:GREEN-PADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6800 WISCONSIN AVE # 1176
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6105
Mailing Address - Country:US
Mailing Address - Phone:301-330-0400
Mailing Address - Fax:301-591-4045
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00535372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211004100Medicaid
MDF73405Medicare UPIN