Provider Demographics
NPI:1164400289
Name:JORDAN, JANINE M (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
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:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 W 14TH ST
Practice Address - Street 2:WILMINGTON HOSPITAL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19899
Practice Address - Country:US
Practice Address - Phone:302-428-4900
Practice Address - Fax:302-428-2663
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG20883Medicare UPIN
DEG01422C02Medicare PIN