Provider Demographics
NPI:1508939752
Name:ROMERO-PANTAZOPOULOS, TATIANA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:ROMERO-PANTAZOPOULOS
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 1:26 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3913
Mailing Address - Country:US
Mailing Address - Phone:617-665-1019
Mailing Address - Fax:
Practice Address - Street 1:CAMBRIDGE HOSPITAL
Practice Address - Street 2:1493 CAMBRIDGE STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-665-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA40796Medicare PIN