Healthcare Provider Details

I. General information

NPI: 1629073432
Provider Name (Legal Business Name): IRENE JAFFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

3833 FAIRFAX DR SUITE 200
ARLINGTON VA
22203-1772
US

IV. Provider business mailing address

1469 WAGGAMAN CIR
MC LEAN VA
22101-4029
US

V. Phone/Fax

Practice location:
  • Phone: 703-525-8863
  • Fax: 703-525-2387
Mailing address:
  • Phone: 703-525-8863
  • Fax: 703-525-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: