Provider Demographics
NPI:1417981960
Name:TILLMANNS, REGINE (MD)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:TILLMANNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2711
Mailing Address - Country:US
Mailing Address - Phone:781-662-3141
Mailing Address - Fax:781-662-2210
Practice Address - Street 1:830 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2711
Practice Address - Country:US
Practice Address - Phone:781-662-3141
Practice Address - Fax:781-662-2210
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2148030Medicaid
MA2148030Medicaid
MA000431501Medicare PIN