Provider Demographics
NPI:1346209640
Name:JORDAN, RACHEL E (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:JORDAN
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 1:250 PLEASANT ST
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-225-2711
Mailing Address - Fax:603-224-6527
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-225-2711
Practice Address - Fax:603-224-6527
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11565207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
6010899OtherMVP
NH01Y003783NH04OtherANTHEM
20251YOtherNHBS RAN
7433333OtherAETNA
01Y003783NH04OtherANTHEM
MA2096111Medicaid
P00184193OtherRAILROAD MEDICARE
NH30202077Medicaid
44289OtherHARVARD
NH7433333OtherAETNA
P00184193OtherRAILROAD MEDICARE
MA2096111Medicaid
H63038Medicare UPIN