Healthcare Provider Details

I. General information

NPI: 1881794329
Provider Name (Legal Business Name): MARC A. JAFFE, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 AMARAL ST
RIVERSIDE RI
02915-2205
US

IV. Provider business mailing address

38 AMARAL ST
RIVERSIDE RI
02915-2205
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-3300
  • Fax: 401-434-5313
Mailing address:
  • Phone: 401-438-3300
  • Fax: 401-434-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6075
License Number StateRI

VIII. Authorized Official

Name: DR. MARC A. JAFFE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-438-3300