Provider Demographics
NPI:1235286626
Name:JORDAN, PETER MANNING (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MANNING
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:336-851-8427
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-272-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30558207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500770OtherUNITED HEALTHCARE
060039916OtherRR MEDICARE
1142OtherPARTNERS MEDICARE
NC8947479Medicaid
561240263OtherCOMMERCIAL
1142OtherPARTNERS
NC47479OtherBCBS
1142OtherPARTNERS
561240263OtherCOMMERCIAL