Provider Demographics
NPI:1912130584
Name:JAFF, TWANA (MD)
Entity Type:Individual
Prefix:
First Name:TWANA
Middle Name:
Last Name:JAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TWANA
Other - Middle Name:H
Other - Last Name:FARAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107A BROOKDALE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4501
Mailing Address - Country:US
Mailing Address - Phone:276-670-3300
Mailing Address - Fax:
Practice Address - Street 1:1107A BROOKDALE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4501
Practice Address - Country:US
Practice Address - Phone:276-670-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01628207R00000X
TN65527207R00000X
VA0101251210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine