Healthcare Provider Details

I. General information

NPI: 1467680280
Provider Name (Legal Business Name): PARISA R JORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PARISA RAVANFAR M.D.

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SOUTHWOOD DR DHMC DEPARTMENT OF DERMATOLOGY
NASHUA NH
03063-1818
US

IV. Provider business mailing address

2300 SOUTHWOOD DR DHMC DEPARTMENT OF DERMATOLOGY
NASHUA NH
03063-1818
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-4260
  • Fax:
Mailing address:
  • Phone: 603-577-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberLT 3245
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number16085
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number16085
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: