Provider Demographics
NPI:1013903822
Name:ELIASSI-RAD, BABAK (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:ELIASSI-RAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FAUNCE CORNER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1255
Mailing Address - Country:US
Mailing Address - Phone:508-717-0270
Mailing Address - Fax:508-717-0268
Practice Address - Street 1:500 FAUNCE CORNER RD STE 110
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1255
Practice Address - Country:US
Practice Address - Phone:508-717-0270
Practice Address - Fax:508-717-0270
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205945207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ23120OtherBCBS
MA2485325OtherAETNA
MA152365BMCOtherHARVARD PILGRIM HEALTH CA
MA205945OtherTUFTS
MA2485325OtherAETNA
MA2485325OtherAETNA
MAA31795Medicare ID - Type Unspecified