Provider Demographics
NPI:1215957543
Name:DAHER, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:DAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DAHER
Other - Last Name:FASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:110 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493
Mailing Address - Country:US
Mailing Address - Phone:617-723-2020
Mailing Address - Fax:781-642-7746
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:781-235-1947
Practice Address - Fax:781-642-7746
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73692207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3083128Medicaid
MA3083128Medicaid
E98020Medicare UPIN