Healthcare Provider Details

I. General information

NPI: 1831180504
Provider Name (Legal Business Name): TANIA J. PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET SHAPIRO 8
BOSTON MA
02118
US

IV. Provider business mailing address

850 HARRISON AVE YACC BN-C7
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-7420
  • Fax: 617-638-7289
Mailing address:
  • Phone: 617-414-5405
  • Fax: 617-414-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number72540
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: