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General NPI Number Information
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NPI Number | 1013479955
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Entity Type | Individual
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Provider Name | LEAH RAE PRAGER PA-C, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 75 FRANCIS STREET
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-732-6819
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Fax |
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Provider Business Mailing Address
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Address Line | 829 S LA GRANGE RD UNIT A
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City | LA GRANGE
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State | IL
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Zip | 60525-2920
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Country | US
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Telephone | 603-731-3493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA8767
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License Number State | MA
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