1871535534 NPI number — DR. TAHIR TELLIOGLU M.D.

Table of content: DR. TAHIR TELLIOGLU M.D. (NPI 1871535534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871535534 NPI number — DR. TAHIR TELLIOGLU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TELLIOGLU
Provider First Name:
TAHIR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871535534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 JOSEPH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-9545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-843-2928
Provider Business Mailing Address Fax Number:
270-216-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BLOSSOM ST
Provider Second Line Business Practice Location Address:
MGH COX CLINIC
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-0211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-643-5457
Provider Business Practice Location Address Fax Number:
617-726-8950
Provider Enumeration Date:
06/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD12140 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 043151 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: 277173 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11583072 . This is a "CAQH PROVIDER ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".