Provider Demographics
NPI:1831518810
Name:WATSON, JORDAN NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICHOLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ROCKLAND RD
Mailing Address - Street 2:SUITE 2B80
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3607
Mailing Address - Country:US
Mailing Address - Phone:302-651-5874
Mailing Address - Fax:302-651-5954
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:SUITE 2B80
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-651-5874
Practice Address - Fax:302-651-5954
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460253208000000X
DEC1-0011626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics