Healthcare Provider Details

I. General information

NPI: 1851359632
Provider Name (Legal Business Name): SUSAN WEITZ JAFFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 EXECUTIVE BLVD SUITE 300
ROCKVILLE MD
20852-3803
US

IV. Provider business mailing address

6000 EXECUTIVE BLVD SUITE 300
ROCKVILLE MD
20852-3803
US

V. Phone/Fax

Practice location:
  • Phone: 301-468-8999
  • Fax:
Mailing address:
  • Phone: 301-468-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD26641
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: