Active NPI
Jorge Enrique Tello, MD
- Internal Medicine Physician
- Milton, MA
National Provider Identifier
1831105162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 38537
- Practice address
- 630 Adams St
Milton, MA 02186-5631 - Phone
- (617) 698-0910
- Fax
- (617) 696-3722
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 38537 | MA | Primary |
| Medical Oncology Physician | 207RX0202X | 38537 | MA |
Addresses
Primary practice location
630 Adams St
Milton, MA 02186-5631
Mailing address
2110 Dorchester Ave
Suite 302
Dorchester, MA 02124-5699
Phone (617) 698-0910
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TEM09072 | Other | MA | BLUE CROSS BLUE SHIELD MA |
| 2039052 | Medicaid | MA | |
| 6359 | Other | MA | HARVARD PILGRIM HC |
| 038537 | Other | MA | TUFTS HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1831105162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 DORCHESTER AVE",
"address_2": "SUITE 302",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021245699",
"telephone_number": "617-698-0910",
"fax_number": "617-696-3722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 ADAMS ST",
"city": "MILTON",
"state": "MA",
"postal_code": "021865631",
"telephone_number": "617-698-0910",
"fax_number": "617-696-3722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLO",
"first_name": "JORGE",
"middle_name": "ENRIQUE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "38537",
"primary": true
},
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "MA",
"license": "38537",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MA",
"identifier": "TEM09072",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2039052",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HC",
"identifier": "6359",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "038537",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.