Provider Demographics
NPI:1598225625
Name:SWENSON, JORDAN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DOUGLAS
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3474
Mailing Address - Country:US
Mailing Address - Phone:518-549-6000
Mailing Address - Fax:518-262-6111
Practice Address - Street 1:75 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3474
Practice Address - Country:US
Practice Address - Phone:518-549-6000
Practice Address - Fax:518-262-6111
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3121332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry