Provider Demographics
NPI:1598759961
Name:TILLINGER, BENJAMIN ARI (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ARI
Last Name:TILLINGER
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 1:41 MALL RD
Mailing Address - Street 2:CARDIOVASCULAR MEDICINE
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8002
Mailing Address - Fax:781-744-5261
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:CARDIOVASCULAR MEDICINE
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0002
Practice Address - Country:US
Practice Address - Phone:781-744-8000
Practice Address - Fax:781-744-5261
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222042207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2106299Medicaid
MA2106299Medicaid
MAA38838Medicare PIN