Provider Demographics
NPI:1619126208
Name:JAAFAR, RANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDA
Middle Name:
Last Name:JAAFAR
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 1:250 E 49TH ST APT 17A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1580
Mailing Address - Country:US
Mailing Address - Phone:313-204-8040
Mailing Address - Fax:
Practice Address - Street 1:250 E 49TH ST APT 17A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1580
Practice Address - Country:US
Practice Address - Phone:313-204-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207L00000X207L00000X
OH35-092622207L00000X
NY261144207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03488497Medicaid
OH0051112Medicaid
OHP01071269OtherMEDICARE RAILROAD