Provider Demographics
NPI:1770521080
Name:JORDAN, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2546 BALLTOWN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1079
Mailing Address - Country:US
Mailing Address - Phone:518-377-8184
Mailing Address - Fax:518-374-5918
Practice Address - Street 1:2546 BALLTOWN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1079
Practice Address - Country:US
Practice Address - Phone:518-377-8184
Practice Address - Fax:518-374-5918
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-08-15
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Provider Licenses
StateLicense IDTaxonomies
NY185349207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease