Provider Demographics
NPI:1871535534
Name:TELLIOGLU, TAHIR (MD)
Entity type:Individual
Prefix:DR
First Name:TAHIR
Middle Name:
Last Name:TELLIOGLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JOSEPH CT
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9545
Mailing Address - Country:US
Mailing Address - Phone:203-843-2928
Mailing Address - Fax:270-216-6261
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:MGH COX CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-0211
Practice Address - Country:US
Practice Address - Phone:617-643-5457
Practice Address - Fax:617-726-8950
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD121402084P0800X
CT0431512084P0800X
MA2771732084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI11583072OtherCAQH PROVIDER ID
RI11583072OtherCAQH PROVIDER ID