Provider Demographics
NPI:1326063694
Name:TANABE, STEVEN M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:TANABE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3800
Mailing Address - Country:US
Mailing Address - Phone:781-259-1530
Mailing Address - Fax:
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:TUFTS-NEMC #314
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5848
Practice Address - Fax:617-636-8199
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1604572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA111161OtherHARVARD PILGRIM
MA408267OtherTUFTS
MA0663325OtherMASS HEALTH
MAJ24299OtherBCBS MEDICARE
MAJ24299OtherBCBS MEDICARE