Basic Information
| Provider Information | |||||||||
| NPI: | 1376529040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORDAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MCLEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1084 VINEHAVEN DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047865131 | ||||||||
| FaxNumber: | 7047844129 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 VINEHAVEN DR | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047865131 | ||||||||
| FaxNumber: | 7047844129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 16441 | NC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 8963010 | 05 | NC | MEDICAID |