Provider Demographics
NPI:1851359632
Name:JAFFE, SUSAN WEITZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WEITZ
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 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3803
Mailing Address - Country:US
Mailing Address - Phone:301-468-8999
Mailing Address - Fax:
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-468-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26641207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521186611OtherUNITED HEALTHCARE PROV #
MD625311OtherMAMSI PROVIDER NUMBER
MD0634522OtherCIGNA PROVIDER NUMBER
MD4086379OtherAETNA HMO PROVIDER NUMBER
MD625311OtherOPTIMUM CHOICE PROVIDER #
MD606242OtherBSMD PROVIDER NUMBER
MD9070 0011OtherBSDC PROVIDER NUMBER
MD625311OtherALLIANCE PROVIDER NUMBER
MD019189OtherJHHC PROVIDER NUMBER
MD4086379OtherAETNA PPO PROVIDER NUMBER
MD625311OtherMDIPA PROVIDER NUMBER
MD019189OtherJHHC PROVIDER NUMBER
MD0634522OtherCIGNA PROVIDER NUMBER