Tantillo, Michael Blair

Tantillo, Michael Blair is an individual health care provider with primary practice located at 25 Boylston Street Suite 304, Chestnut Hill MA 02467. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Tantillo, Michael Blair can be contacted via phone (617) 505-6818.

Contact Information

Primary practice address
25 Boylston Street Suite 304 Chestnut Hill MA 02467
Phone: (617) 505-6818
Fax: (617) 505-6813
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 19264 New Hampshire
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 74194 Massachusetts

Profile Details

NPI number 1841281227
LBN Legal business name Tantillo, Michael Blair
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2005
Last updated Nov 30th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841281227 NPPES
Massachusetts MEDICAID 3192873

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