Provider Demographics
NPI:1689825036
Name:JORDAN, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8180 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8180 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2524
Practice Address - Country:US
Practice Address - Phone:301-776-6007
Practice Address - Fax:301-776-6678
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies