Provider Demographics
NPI:1114593944
Name:SMITH, JORDAN LEIGH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3323
Mailing Address - Country:US
Mailing Address - Phone:260-402-1940
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
Practice Address - Street 2:55 LAKE AVENUE NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-334-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program