Provider Demographics
NPI:1699757781
Name:JAFFER, ADIL N (MD)
Entity type:Individual
Prefix:DR
First Name:ADIL
Middle Name:N
Last Name:JAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1052
Mailing Address - Country:US
Mailing Address - Phone:330-759-7038
Mailing Address - Fax:330-759-7071
Practice Address - Street 1:4308 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1052
Practice Address - Country:US
Practice Address - Phone:330-759-7038
Practice Address - Fax:330-759-7071
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00208539OtherPALMETTO GBA- RR MEDICARE
OH36D0341980OtherCLIA
OH2560876Medicaid
OHI23981Medicare UPIN
OHJA4150123Medicare PIN