1639178569 NPI number — MARJORIE RAH OD

Table of content: MARJORIE RAH OD (NPI 1639178569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639178569 NPI number — MARJORIE RAH OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAH
Provider First Name:
MARJORIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639178569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 COMMONWEALTH AVE
Provider Second Line Business Mailing Address:
SUITE 2A NEW ENGLAND EYE INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-262-2020
Provider Business Mailing Address Fax Number:
617-236-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
SUITE 2A NEW ENGLAND EYE INSTITUTE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-262-2020
Provider Business Practice Location Address Fax Number:
617-236-6323
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4237 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2048274 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5426454 . This is a "FH CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 73083 . This is a "CMSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 977297 . This is a "NETWORK HEALTH GRP 40403" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0336441 . This is a "MASS HEALTH GROUP 9721100" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0336441 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W17386 . This is a "MEDICARE W21056" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16348 . This is a "BCBS W20072 OD NO BLUE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1404530 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 153341 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3164443 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 791541 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA4231 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30556 . This is a "BMC HEALTHNET ADD 7 0S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32051 . This is a "NHP 0026263" identifier . This identifiers is of the category "OTHER".
  • Identifier: 625167 . This is a "CIGNA GROUP 62516" identifier . This identifiers is of the category "OTHER".




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