Provider Demographics
NPI:1528136827
Name:TILLES, ARNO WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:ARNO
Middle Name:WILLIAM
Last Name:TILLES
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 1:10 ROGERS ST
Mailing Address - Street 2:#1201
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1246
Mailing Address - Country:US
Mailing Address - Phone:305-215-2888
Mailing Address - Fax:
Practice Address - Street 1:10 ROGERS ST
Practice Address - Street 2:#1201
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1246
Practice Address - Country:US
Practice Address - Phone:305-215-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208961207R00000X
FLME67418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine