Provider Demographics
NPI:1639178569
Name:RAH, MARJORIE (OD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:RAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 2A NEW ENGLAND EYE INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-262-2020
Mailing Address - Fax:617-236-6323
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 2A NEW ENGLAND EYE INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-262-2020
Practice Address - Fax:617-236-6323
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048274OtherFIRST HEALTH
5426454OtherFH CCN
73083OtherCMSP
977297OtherNETWORK HEALTH GRP 40403
0336441OtherMASS HEALTH GROUP 9721100
MA0336441Medicaid
W17386OtherMEDICARE W21056
W16348OtherBCBS W20072 OD NO BLUE 65
1404530OtherUNITED HEALTH CARE
153341OtherHARVARD PILGRIM
3164443OtherAETNA
MA791541Medicaid
MA4231OtherEYEMED
30556OtherBMC HEALTHNET ADD 7 0S
32051OtherNHP 0026263
625167OtherCIGNA GROUP 62516
MAW17386Medicare ID - Type Unspecified
MA791541Medicaid