Provider Demographics
NPI:1033117502
Name:DAVID, JOSEPH JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JORDAN
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:535 WESTFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-973-9739
Mailing Address - Fax:434-973-0756
Practice Address - Street 1:535 WESTFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-973-9739
Practice Address - Fax:434-973-0756
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010353652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA260000521OtherMEDICARE PTAN
VA260000521OtherMEDICARE PTAN