Provider Demographics
NPI:1417126129
Name:DRS JAFFE, ONEILL & LINDGREN,P A
Entity Type:Organization
Organization Name:DRS JAFFE, ONEILL & LINDGREN,P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-530-4800
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-4800
Mailing Address - Fax:301-530-1847
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 402
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-4800
Practice Address - Fax:301-530-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC748009Medicare PIN