Provider Demographics
NPI:1912352659
Name:COHEN, JORDAN J (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 FOULK RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2764
Mailing Address - Country:US
Mailing Address - Phone:302-477-3300
Mailing Address - Fax:302-477-3168
Practice Address - Street 1:1401 FOULK RD STE 100B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2764
Practice Address - Country:US
Practice Address - Phone:302-477-3300
Practice Address - Fax:302-477-3168
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020283207Q00000X, 207QS0010X
DEC2-0013697207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine