Healthcare Provider Details

I. General information

NPI: 1114677135
Provider Name (Legal Business Name): SEAN WILHERE JORDAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 KING OF PRUSSIA ROAD SUITE 301 NORTH
RADNOR PA
19087-4557
US

IV. Provider business mailing address

145 KING OF PRUSSIA ROAD SUITE 301 NORTH
RADNOR PA
19087-4557
US

V. Phone/Fax

Practice location:
  • Phone: 610-902-2450
  • Fax: 610-902-2466
Mailing address:
  • Phone: 610-902-2450
  • Fax: 610-902-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD490752
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: