Provider Demographics
NPI:1013912468
Name:JAFFE, ELIZABETH F (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:F
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 1:53 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5201
Mailing Address - Country:US
Mailing Address - Phone:802-864-0294
Mailing Address - Fax:802-864-3779
Practice Address - Street 1:53 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5201
Practice Address - Country:US
Practice Address - Phone:802-864-0294
Practice Address - Fax:802-864-3779
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-000-9472207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01744370Medicaid
VT0VN1559Medicaid
VT29424OtherBLUE CROSS BLUE SHIELD VT
VT321950OtherMVP
VT0369325-002OtherCIGNA
NY82X031OtherBCBS NORTHEAST NEW YORK
VT321950OtherMVP
JAVT1559Medicare ID - Type Unspecified