Michael Blair Tantillo (NPI# 1841281227, PAC ID# 5496700791) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PLASTIC AND RECONSTRUCTIVE SURGERY.
| Nation Provider ID (NPI) | 1841281227 |
| PAC ID by PECOS | 5496700791 |
| Professional Enrollment ID | I20110901000385 |
| Full Name | Michael Blair Tantillo |
| Organization Legal Name | NORTHEAST DERMATOLOGY ASSOCIATES PC |
| Address |
1208 B Vfw Pkwy Suite 200 West Roxbury MA 02132-4350 |
| Phone Number | 9786915690 |
| Gender | M |
| Medical School | UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE |
| Graduation Year | 1989 |
| Primary Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| Group Practice PAC ID | 3072403799 |
| Number of Group Practice Members | 46 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 300012 | ELLIOT HOSPITAL |
| 300003 | MARY HITCHCOCK MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 235 Cypress St, Suite 200, Brookline, MA 02445-6777 | 9786915690 | NORTHEAST DERMATOLOGY ASSOCIATES PC |
| 100 Hitchcock Way, Manchester, NH 03104-4125 | 6036952500 | DARTMOUTH-HITCHCOCK CLINIC |
| 1208 B Vfw Pkwy, Suite 200, West Roxbury, MA 02132-4350 | 9786915690 | NORTHEAST DERMATOLOGY ASSOCIATES PC |
| 1208 B Vfw Pkwy, Suite 200, West Roxbury, MA 02132-4350 | 6176081575 | BROOKLINE DERMATOLOGY ASSOCIATES, PC |
| Organization Legal Name | NORTHEAST DERMATOLOGY ASSOCIATES PC |
| Physicians | 45 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ashley Smyth | Nurse Practitioner | Northeast Dermatology Associates PC | 155 Borthwick Ave, Portsmouth, NH 03801-7156 |
| Sheli L Tinkelman | Physician Assistant | Northeast Dermatology Associates PC | 197 Loudon Rd, Suite 350, Concord, NH 03301-8000 |
| Brienne Danielle Cressey | Dermatology | Northeast Dermatology Associates PC | 51 Webb Pl, Dover, NH 03820-2454 |
| Sarit J Itenberg | Dermatology | Northeast Dermatology Associates PC | 23 Hampton Rd, Exeter, NH 03833-4807 |
| Jennifer A Stead | Dermatology | Northeast Dermatology Associates PC | 75 Gilcrest Rd, Unit 100, Londonderry, NH 03053-3564 |
| Debra A Litke | Nurse Practitioner | Northeast Dermatology Associates PC | 530 C Boston Post Rd, Sudbury, MA 01776-3349 |
| Anthony J Aversa | Dermatology | Northeast Dermatology Associates PC | 721 Chestnut St, Manchester, NH 03104-3002 |
| Christine Kannler | Dermatology | Northeast Dermatology Associates PC | 538 Turnpike St, North Andover, MA 01845-5812 |
| Joan S Sisto | Dermatology | Northeast Dermatology Associates PC | 519 Us Route 1, Unit 2, York, ME 03909-1683 |
| David S Greenstein | Dermatology | Northeast Dermatology Associates PC | 138 Conant St, Beverly, MA 01915-1665 |
| Street Address |
1208 B VFW PKWY SUITE 200 |
| City | WEST ROXBURY |
| State | MA |
| Zip | 02132-4350 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary Ann Cassel | Qualified Audiologist | Boston Ent Associates PC | 1208 B Vfw Pkwy, Suite 303, West Roxbury, MA 02132-4350 |
| Andrew Wang | Dermatology | Northeast Dermatology Associates PC | 1208 B Vfw Pkwy, Suite 200, West Roxbury, MA 02132-4350 |
| Brian W Lester | Dermatology | Northeast Dermatology Associates PC | 1208 B Vfw Pkwy, Suite 200, West Roxbury, MA 02132-4350 |
| Stephen R Lyle | Pathology | Northeast Dermatology Associates PC | 1208 B Vfw Pkwy, Suite 200, West Roxbury, MA 02132-4350 |
| Jason B Mchugh | Physical Therapy | Beantown Physio, Inc | 1208 B Vfw Pkwy, Suite 202, West Roxbury, MA 02132-4350 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John H Halpern | Psychiatry | Community Services Institute, Inc. | 540 Vfw Pkwy, West Roxbury, MA 02132-1332 |
| Mark A Apazidis | Chiropractic | 1765 Centre St, West Roxbury, MA 02132-1535 | |
| Dhirendra S Bana | Internal Medicine | 19 Alhambra Rd, West Roxbury, MA 02132-1815 | |
| Rosemary M Harbeson | Clinical Social Worker | Brigham and Womens Physicians Organization Inc | 1832 Centre St, West Roxbury, MA 02132-1901 |
| Edward A Siegel | Podiatry | 81 Corey St, West Roxbury, MA 02132-2344 | |
| David S Greenstein | Optometry | 81 Corey St, West Roxbury, MA 02132-2345 | |
| Riley Fake | Chiropractic | Milton Chiropractic and Rehabilitation Inc | 1914 Centre St, West Roxbury, MA 02132-2535 |
| Alyssa Bissonnette | Physical Therapy | Bay State Physical Therapy of Randolph Inc | 1914 Centre St, West Roxbury, MA 02132-2535 |
| Ian Wedemeyer | Physical Therapy | Milton Chiropractic and Rehabilitation Inc | 1914 Centre St, West Roxbury, MA 02132-2535 |
| Sarah L Minden | Psychiatry | 238 Vermont St, West Roxbury, MA 02132-2833 | |
| Find all physicians in zip 02132 | |||
| City | WEST ROXBURY |
| Zip Code | 02132 |
| Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| City + Specialty | WEST ROXBURY + PLASTIC AND RECONSTRUCTIVE SURGERY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.