Provider Demographics
NPI:1649388018
Name:RAUWERDINK, COCAV ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:COCAV
Middle Name:ANNA
Last Name:RAUWERDINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COCAV
Other - Middle Name:ANNA
Other - Last Name:ENGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 TSIENNETO RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1584
Mailing Address - Country:US
Mailing Address - Phone:603-537-2060
Mailing Address - Fax:
Practice Address - Street 1:6 TSIENNETO RD
Practice Address - Street 2:LAHEY PARKLAND ONOCOLOGY
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-432-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13242207RH0003X
MA253662207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018016Medicaid
NH30209817Medicaid
MA001758604Medicare PIN
NH001758601Medicare PIN