Provider Demographics
NPI:1508569112
Name:TYRRELL, JORDAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:JAMES
Last Name:TYRRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 SUMMERS DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1619
Mailing Address - Country:US
Mailing Address - Phone:571-331-0420
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVENUE
Practice Address - Street 2:HOFHEIMER HALL, SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:892-075-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program