Basic Information
| Provider Information | |||||||||
| NPI: | 1639178569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAH | ||||||||
| FirstName: | MARJORIE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | SUITE 2A NEW ENGLAND EYE INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | SUITE 2A NEW ENGLAND EYE INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4237 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2048274 | 01 | FIRST HEALTH | OTHER | 5426454 | 01 | FH CCN | OTHER | 73083 | 01 | CMSP | OTHER | 977297 | 01 | NETWORK HEALTH GRP 40403 | OTHER | 0336441 | 01 | MASS HEALTH GROUP 9721100 | OTHER | 0336441 | 05 | MA | MEDICAID | W17386 | 01 | MEDICARE W21056 | OTHER | W16348 | 01 | BCBS W20072 OD NO BLUE 65 | OTHER | 1404530 | 01 | UNITED HEALTH CARE | OTHER | 153341 | 01 | HARVARD PILGRIM | OTHER | 3164443 | 01 | AETNA | OTHER | 791541 | 05 | MA | MEDICAID | MA4231 | 01 | EYEMED | OTHER | 30556 | 01 | BMC HEALTHNET ADD 7 0S | OTHER | 32051 | 01 | NHP 0026263 | OTHER | 625167 | 01 | CIGNA GROUP 62516 | OTHER |