Organization
JORDAN PHYSICIAN ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN COUGHLIN (PRESIDENT)
(508) 746-2000
Entity
Organization
Contact information
Practice address
275 SANDWICH ST, PLYMOUTH, MA 02360-2183
(508) 830-2401
(508) 830-1131
Mailing address
36 CORDAGE PARK CIR, SUITE 317, PLYMOUTH, MA 02360-7331
(508) 830-2428
(508) 830-2502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110072193A
—
MA
01
—
602198
TUFTS HEALTH PLAN
MA
01
—
AA229234
HARVARD PILGRIM HEALTHCARE
MA
01
—
M15987
BCBSMA
MA
Enumeration date
12/16/2005
Last updated
12/15/2021
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