Healthcare Provider Details

I. General information

NPI: 1144627100
Provider Name (Legal Business Name): JORDAN TREWORGY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 03/07/2023
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CORLISS LN
COLEBROOK NH
03576-3207
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 603-237-8652
  • Fax:
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2017-0661
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20174
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: