Provider Demographics
NPI:1699759423
Name:JAFFE, SETH L (DO)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:L
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10508 PARK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8526
Mailing Address - Country:US
Mailing Address - Phone:704-541-3055
Mailing Address - Fax:704-319-2166
Practice Address - Street 1:10508 PARK RD STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8526
Practice Address - Country:US
Practice Address - Phone:704-541-3055
Practice Address - Fax:704-319-2166
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001495207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891274WMedicaid
SCT00309Medicaid
SCT00309Medicaid
SCF740854632Medicare ID - Type Unspecified
NC891274WMedicaid