Healthcare Provider Details

I. General information

NPI: 1306021076
Provider Name (Legal Business Name): JORDAN ELLIOT ANGELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALCOLM DR SUITE A
WESTMINSTER MD
21157-6160
US

IV. Provider business mailing address

25 CROSSROADS DR SUITE 306
OWINGS MILLS MD
21117-5421
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-1633
  • Fax: 410-840-2100
Mailing address:
  • Phone: 443-738-2872
  • Fax: 443-738-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35098754
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0075473
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: