Healthcare Provider Details

I. General information

NPI: 1134535156
Provider Name (Legal Business Name): JORDAN HOACHLANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 MYOMA RD
MARS PA
16046-2324
US

IV. Provider business mailing address

518 MYOMA RD
MARS PA
16046-2324
US

V. Phone/Fax

Practice location:
  • Phone: 724-778-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006545
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: