Healthcare Provider Details

I. General information

NPI: 1417481359
Provider Name (Legal Business Name): ALEXANDER CLAUDIUS JORDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # 205
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST # 205
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4095
  • Fax: 203-785-4116
Mailing address:
  • Phone: 203-785-4095
  • Fax: 203-785-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number84608
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: