Provider Demographics
NPI:1568561462
Name:JORDAN, CHARLES E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:751 PRE EMPTION RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-2849
Mailing Address - Fax:315-789-2866
Practice Address - Street 1:751 PRE EMPTION RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-2849
Practice Address - Fax:315-789-2866
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1316421207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
16800BMedicare ID - Type Unspecified