Provider Demographics
NPI:1831180504
Name:PHILLIPS, TANIA J (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:850 HARRISON AVE
Mailing Address - Street 2:YACC BN-C7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:725 ALBANY STREET
Practice Address - Street 2:SHAPIRO 8
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-7420
Practice Address - Fax:617-638-7289
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-12-20
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Provider Licenses
StateLicense IDTaxonomies
MA72540207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3068358Medicaid
E65265Medicare UPIN
MAJ10406Medicare PIN