Provider Demographics
NPI:1043913304
Name:WAGIEALLA, RAWAN (MD)
Entity Type:Individual
Prefix:
First Name:RAWAN
Middle Name:
Last Name:WAGIEALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOUNT VERNON STREET
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108
Mailing Address - Country:US
Mailing Address - Phone:857-829-0800
Mailing Address - Fax:
Practice Address - Street 1:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL
Practice Address - Street 2:225 EAST CHICAGO AVENUE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program