Provider Demographics
NPI:1538166889
Name:TANEV, KALOYAN S (MD)
Entity type:Individual
Prefix:
First Name:KALOYAN
Middle Name:S
Last Name:TANEV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:WARREN 1220
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-7511
Mailing Address - Fax:617-724-9155
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WARREN 1220
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-7511
Practice Address - Fax:617-724-9155
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2351952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG88942Medicare UPIN
MATA RE7072Medicare PIN