Provider Demographics
NPI:1609843994
Name:JOURDEN, MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:JOURDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-0203
Mailing Address - Country:US
Mailing Address - Phone:804-541-6666
Mailing Address - Fax:
Practice Address - Street 1:50 MEDICAL PARK BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:804-732-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA102201039207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6204503Medicaid
VAH35056Medicare UPIN