Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 205945 | MA |
NPI | 1013903822 |
---|---|
Provider Name | Dr. Babak Eliassi-Rad |
First Address | Taunton, MA 02780-1085 |
Second Address | Taunton, MA 02780-1085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 01/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152365BMC | HARVARD PILGRIM HEALTH CA (01) | MA |
205945 | TUFTS (01) | MA |
2485325 | AETNA (01) | MA |
H28047 | (02) | MA |
J23120 | BCBS (01) | MA |