Healthcare Provider Details

I. General information

NPI: 1205464401
Provider Name (Legal Business Name): JORDAN LEIGH HILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN TATE MD

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

1709 FOREST GLEN RD
SILVER SPRING MD
20910-1409
US

V. Phone/Fax

Practice location:
  • Phone: 773-776-6652
  • Fax:
Mailing address:
  • Phone: 304-395-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116033841
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: