Provider Demographics
NPI:1629073432
Name:JAFFE, IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
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 1:1469 WAGGAMAN CIR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4029
Mailing Address - Country:US
Mailing Address - Phone:703-525-8863
Mailing Address - Fax:703-525-2387
Practice Address - Street 1:3833 FAIRFAX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1772
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:703-525-2387
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-12-01
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
NY221826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH42721Medicare UPIN