Provider Demographics
NPI:1942510045
Name:T. ATILLA CERANOGLU, MD, PC
Entity Type:Organization
Organization Name:T. ATILLA CERANOGLU, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOLGA
Authorized Official - Middle Name:ATILLA
Authorized Official - Last Name:CERANOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-296-5437
Mailing Address - Street 1:75 ADAMS ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3432
Mailing Address - Country:US
Mailing Address - Phone:617-296-5437
Mailing Address - Fax:617-273-5112
Practice Address - Street 1:75 ADAMS ST
Practice Address - Street 2:SUITE G
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3432
Practice Address - Country:US
Practice Address - Phone:617-296-5437
Practice Address - Fax:617-273-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215949261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health