# KHADIJAH Y. JORDAN, MD.,PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912014093
- **Authorized official:** DR. KHADIJAH Y JORDAN M.D. (PRESIDENT)
- **Authorized official phone:** (757) 436-2424

## Contact information

- **Practice address:** 111 MEDICAL PKWY, SUITE 202, CHESAPEAKE, VA 23320-0302
- **Practice address phone:** (757) 436-2424
- **Practice address fax:** (757) 436-6628
- **Mailing address:** 111 MEDICAL PKWY, SUITE 202, CHESAPEAKE, VA 23320-0302
- **Mailing address phone:** (757) 436-2424
- **Mailing address fax:** (757) 436-6628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 0101052592 | VA | Yes |

## Other

- **Enumeration date:** 08/24/2006
- **Last updated:** 09/08/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010202531 | — | VA |
| 01 | — | 178986 | ANTHEM | VA |
| 01 | — | 2133107 | MAMSI | — |
| 01 | — | 24104 | OPTIMA | VA |
| 01 | — | 5025116 | CIGNA | VA |