Michael Blair Tantillo, MD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

74194 Issued in MA

Practice address

25 Boylston Street
Suite 304
Chestnut Hill, MA 02467

Phone

(617) 505-6818

Fax

(617) 505-6813

NPI assigned

Nov 3, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA, NH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Steward Medical Group, Inc

  • Specialist
  • Watertown, MA
  • NPI 1629398219
  Medicare reassignment NPD
• Dartmouth-Hitchcock Clinic

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1548210198
  Medicare reassignment NPD
• Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
  • NPI 1023092053
  Medicare reassignment NPD
• Clareo Aesthetics

  • Plastic Surgery Physician
  • Chestnut Hill, MA
  • NPI 1134762693
  NPD Authorized official
• Neda Brookline LLC

  • Dermatology Physician
  • Brookline, MA
  • NPI 1548746092
  Medicare reassignment
• Steward Medical Group, Inc

  • Specialist
  • Brighton, MA
  • NPI 1356654495
  NPD
• Mary Hitchcock Memorial Hospital

  • Psychiatric Hospital
  • Hampstead, NH
  • NPI 1699584219
  NPD
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  • Surgery Physician
  • Boston, MA
  • NPI 1720037385

  Plastic Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1841281227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 BOYLSTON STREET",
            "address_2": "SUITE 304",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "02467",
            "telephone_number": "617-505-6818",
            "fax_number": "617-505-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 BOYLSTON STREET",
            "address_2": "SUITE 304",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "02467",
            "telephone_number": "617-505-6818",
            "fax_number": "617-505-6813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hitchcock Way",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "03104",
            "country_code": "US",
            "telephone_number": "603-695-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Boylston Street",
            "address_2": "Suite 304",
            "address_purpose": "LOCATION",
            "city": "Chestnut Hill",
            "state": "MA",
            "postal_code": "02467",
            "country_code": "US",
            "telephone_number": "617-505-6818",
            "fax_number": "617-505-6813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANTILLO",
        "first_name": "MICHAEL",
        "middle_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NH",
            "license": "19264",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MA",
            "license": "74194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3192873",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Freedman MD LLC
• Patricia Ann Tabloski, PHD, APRN
• Kathleen Taglieri-Noble I, DPT
• Meredith Welles Talbot, M.D.
• Tingwa Tam
• Olga Tarantseva
• Susan Cloran Taterka, LICSW
• Kathryn Taylor, STUDENT
• Rute Teixeira, MSN, APRN, FNP-C
• Jacquelyn Temple, RN

• Plastic Surgery Physician in Chestnut Hill, MA
• Providers in Chestnut Hill, MA by specialty
• Plastic Surgery Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.