Individual
DAN S TILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
86 BAKER AVE EXTENSION, CONCORD, MA 01742-2125
(978) 287-9300
(978) 287-9357
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45946
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006170
NEIGHBORHOOD HEALTH
MA
05
—
0172723
—
MA
01
—
4109369
AETNA
MA
01
—
65067
HARVARD PILGRIM
MA
01
—
715989
TUFTS
MA
01
—
B10208102
CIGNA
MA
01
—
J07305
BLUE CROSS
MA
Enumeration date
04/28/2006
Last updated
05/26/2011
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