Healthcare Provider Details

I. General information

NPI: 1639135999
Provider Name (Legal Business Name): GABRIEL B JAFFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD SUITE 300
LANHAM MD
20706
US

IV. Provider business mailing address

8116 GOOD LUCK RD SUITE 300
LANHAM MD
20706-3502
US

V. Phone/Fax

Practice location:
  • Phone: 240-241-7474
  • Fax: 301-731-5733
Mailing address:
  • Phone: 240-241-7474
  • Fax: 301-731-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0016410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: