Basic Information
| Provider Information | |||||||||
| NPI: | 1033137930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | ACADEMIC AFFAIRS CHRISTIANA HOSPITAL | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197180001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027334200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | CCHS PEDIATRIC HOSPITALISTS | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197180001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027336500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C10007721 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | C10007721 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | C10007721 | 01 | DE | STATE OF DE MEDICAL LICEN | OTHER |