Provider Demographics
NPI:1801844048
Name:JORDAN, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:111 FOUNDERS PLZ STE 400
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3240
Mailing Address - Country:US
Mailing Address - Phone:860-289-3375
Mailing Address - Fax:860-783-5733
Practice Address - Street 1:85 SEYMOUR ST STE 200
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5509
Practice Address - Country:US
Practice Address - Phone:860-246-6589
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA817692085R0202X
CT513612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology