Provider Demographics
NPI:1508848722
Name:AHN, AGNES RHEE (DO)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:RHEE
Last Name:AHN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:5TH FLR
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-561-5559
Mailing Address - Fax:617-562-5488
Practice Address - Street 1:886 WASHINGTON ST
Practice Address - Street 2:STE 2
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3445
Practice Address - Country:US
Practice Address - Phone:781-551-3535
Practice Address - Fax:781-255-9994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA74680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3082831Medicaid
E97058Medicare UPIN
MAJ11545Medicare ID - Type Unspecified