Provider Demographics
NPI:1891591269
Name:JAFFE, LOREN
Entity type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:
Last Name:JAFFE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WESTSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3907
Mailing Address - Country:US
Mailing Address - Phone:804-399-4548
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 29504
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23242-0504
Practice Address - Country:US
Practice Address - Phone:804-399-4548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist