Healthcare Provider Details

I. General information

NPI: 1871535534
Provider Name (Legal Business Name): TAHIR TELLIOGLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLOSSOM ST MGH COX CLINIC
BOSTON MA
02114-0211
US

IV. Provider business mailing address

175 JOSEPH CT
WARWICK RI
02886-9545
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-5457
  • Fax: 617-726-8950
Mailing address:
  • Phone: 203-843-2928
  • Fax: 270-216-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD12140
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number043151
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35084
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number277173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: