Provider Demographics
NPI:1306021076
Name:ANGELL, JORDAN ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ELLIOT
Last Name:ANGELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:443-738-2713
Practice Address - Street 1:410 MALCOLM DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6160
Practice Address - Country:US
Practice Address - Phone:410-876-1633
Practice Address - Fax:410-840-2100
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2013-08-22
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Provider Licenses
StateLicense IDTaxonomies
OH35098754208800000X
MDD0075473208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065081Medicaid
MD3362132 00Medicaid
MD281491YZUMedicare PIN
MD3362132 00Medicaid