Provider Demographics
NPI:1275539033
Name:JAFFE, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LIMESTONE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2156
Mailing Address - Country:US
Mailing Address - Phone:302-992-0200
Mailing Address - Fax:302-992-9282
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:STE 300
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2156
Practice Address - Country:US
Practice Address - Phone:302-992-0200
Practice Address - Fax:302-992-9282
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510279425OtherBLUE CROSS BLUE SHIELD
DE290847OtherMAMSI
DE80008266OtherMEDICARE RAILROAD
DE5054OtherCOVENTRY HEALTHCARE
DE4293598OtherAETNA
DE0000453068Medicaid
DE5054OtherCOVENTRY HEALTHCARE
DE510279425OtherBLUE CROSS BLUE SHIELD