Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Thaddeus W Herliczek, MD

Individual provider Pediatric Radiology Physician · NPI 1053457721

Dr. Thaddeus W Herliczek, MD is a Diagnostic Radiology in Boston, Massachusetts. Qualified in 2002, 24 years ago. Practices with Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance, a 115-clinician group and works from 2 locations. Licensed in District of Columbia, Massachusetts, Rhode Island and Washington.

Years since qualifying
24
Licensed in
DC, MA, RI, WA
In the registry since
2007
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

300 Longwood Ave
Boston, MA 02115-5724
Phone: (617) 355-6000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 — (253) 761-4200

Specialties & licences

Pediatric Radiology Physician (primary) Taxonomy 2085P0229X · Licence 231919 (MA)
Pediatric Radiology Physician Taxonomy 2085P0229X · Licence MD500003109 (DC)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 12603 (RI)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence MD70086097 (WA)

Record details

NPI number1053457721
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJanuary 30, 2007
Last updated in NPPESFebruary 4, 2026
Certification dateFebruary 4, 2026
Mailing address300 Longwood Ave, Boston, MA 02115-5724

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Medical Imaging Northwest - Good Samaritan Hospital Imaging Alliance — 115 clinicians
Accepts Medicare assignment Not indicated
Practice locations5 on file with Medicare

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