Provider Demographics
NPI:1215966726
Name:JORDANOV, MARTIN I (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:I
Last Name:JORDANOV
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 1:1161 21ST AVE S
Mailing Address - Street 2:CCC-1121 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2675
Mailing Address - Country:US
Mailing Address - Phone:615-322-3765
Mailing Address - Fax:615-322-3764
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:CCC-1121 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2675
Practice Address - Country:US
Practice Address - Phone:615-322-3765
Practice Address - Fax:615-322-3764
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD396482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
620476822OtherTAX ID