Provider Demographics
NPI:1538636410
Name:PHILIP TRIFFLETTI MD PLLC
Entity Type:Organization
Organization Name:PHILIP TRIFFLETTI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIFFLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-731-7774
Mailing Address - Street 1:25 BOYLSTON ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1710
Mailing Address - Country:US
Mailing Address - Phone:617-731-7774
Mailing Address - Fax:617-731-4534
Practice Address - Street 1:25 BOYLSTON ST STE 211
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1710
Practice Address - Country:US
Practice Address - Phone:617-731-7774
Practice Address - Fax:617-731-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110055816AMedicaid