Healthcare Provider Details

I. General information

NPI: 1649388018
Provider Name (Legal Business Name): COCAV ANNA RAUWERDINK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COCAV ANNA ENGMAN MD

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 01/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD LAHEY PARKLAND ONOCOLOGY
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-1500
  • Fax:
Mailing address:
  • Phone: 603-537-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number13242
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number253662
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: