Provider Demographics
NPI:1144326067
Name:JORDAN, DAVID LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KEY HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5546
Mailing Address - Country:US
Mailing Address - Phone:410-230-7848
Mailing Address - Fax:410-230-7834
Practice Address - Street 1:1420 KEY HWY STE 400
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5546
Practice Address - Country:US
Practice Address - Phone:410-230-7848
Practice Address - Fax:410-230-7834
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58591207L00000X
MDD0058591207LP2900X
NC24777207LP2900X
FLME 91957207LP2900X
NE22541207LP2900X
PAMD028186E207LP2900X
DCFED-DEA AJ9582152207LP2900X
MDCDS-M52836207LP2900X
NY224636-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00182704OtherRR MEDICARE(FREDERICK)
MD230BFR-642828-02OtherBCBS OF MD(FREDERICK)
VAP00190268OtherRR MEDICARE PROV #
DCG853-0001OtherBCBS OF DC (CAREFIRST)
DCK297-0001OtherCAREFIRST BCBS OF DC(FA)
VA139225OtherBCBS OF VA(ANTHEM)HANOVER
MD113621OtherKAISER(PAR PROVIDER #)
VA236758OtherBCBS OF VA (ANTHEM)
VAP00054598OtherRR MEDICARE NUMBER
VA139225OtherBCBS OF VA(ANTHEM)HANOVER
VAB07522Medicare UPIN
MD230BFR-642828-02OtherBCBS OF MD(FREDERICK)
VAP00054598OtherRR MEDICARE NUMBER