Provider Demographics
NPI:1467680280
Name:JORDAN, PARISA R (MD)
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:R
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PARISA
Other - Middle Name:
Other - Last Name:RAVANFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 SOUTHWOOD DR
Mailing Address - Street 2:DHMC DEPARTMENT OF DERMATOLOGY
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1818
Mailing Address - Country:US
Mailing Address - Phone:603-577-4260
Mailing Address - Fax:
Practice Address - Street 1:2300 SOUTHWOOD DR
Practice Address - Street 2:DHMC DEPARTMENT OF DERMATOLOGY
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1818
Practice Address - Country:US
Practice Address - Phone:603-577-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLT 3245207N00000X
NH16085207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082136Medicaid
VT1021347Medicaid