Provider Demographics
NPI:1962473033
Name:JAFFE, DAVID JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
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:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:6433 CENTRALIA RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6556
Practice Address - Country:US
Practice Address - Phone:804-425-3627
Practice Address - Fax:804-425-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012550052084N0402X
NC99012122084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126JJMedicaid
NC2280348AMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NC2346566Medicare ID - Type UnspecifiedGROUP PRICING NUMBER
NC89126JJMedicaid