Provider Demographics
NPI:1598739880
Name:HIROSE, TATSUO (MD)
Entity Type:Individual
Prefix:DR
First Name:TATSUO
Middle Name:
Last Name:HIROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AUTUMN ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5301
Mailing Address - Country:US
Mailing Address - Phone:617-632-7777
Mailing Address - Fax:617-632-7770
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5301
Practice Address - Country:US
Practice Address - Phone:617-632-7777
Practice Address - Fax:617-632-7770
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM08549OtherBCBS MA
MA709545OtherTUFTS HEALTH PLAN
MA709545OtherTUFTS HEALTH PLAN
B75875Medicare UPIN
MAM08549Medicare PIN