Provider Demographics
NPI:1497720247
Name:JAFFE, JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
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 1:2121 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4054
Mailing Address - Country:US
Mailing Address - Phone:301-681-3003
Mailing Address - Fax:301-681-0889
Practice Address - Street 1:2121 MEDICAL PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4054
Practice Address - Country:US
Practice Address - Phone:301-681-3003
Practice Address - Fax:301-681-0889
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME934772085R0202X, 2085R0203X, 2085R0204X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272874500Medicaid
FL272874500Medicaid
C34735Medicare UPIN