Provider Demographics
NPI:1245208297
Name:JAFFE, PIERRE G (MD)
Entity Type:Individual
Prefix:MR
First Name:PIERRE
Middle Name:G
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL PARK
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-256-6648
Mailing Address - Fax:803-256-7239
Practice Address - Street 1:ONE MEDICAL PARK
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-256-6648
Practice Address - Fax:803-256-7239
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22068134Medicaid
B92311Medicare UPIN
SC22068134Medicaid