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									Dear Doctor: It is a pleasure to welcome you to The Physicians of Tufts Medical Center, Inc. and Tufts Medical Center. We look forward to assisting you in the credentialing processes related to your Medical Staff Membership and enrollment in the third party payer panels. Please review the enclosed application and return it to us in the envelope provided, being careful to review the “Appointment Supporting Documentation Checklist” before returning your materials to us. Massachusetts Full License: If you do not already have a full Massachusetts license, MA controlled substance certificate and Federal DEA certificate, please review the information below. Massachusetts licensure can take several months, so it is imperative that you begin the application process as soon as possible. To apply on-line go to: Click on “Physician Information” – go to “Physician Links” – Click on “Downloadable application kits for new full licenses.” You may also reach the Massachusetts Board of Registration in Medicine by phone at 781-876-8200 or fax 781-876-8383. The mailing address is: Commonwealth of Massachusetts Board of Registration in Medicine 200 Harvard Mill Square, Suite 330 Wakefield, MA 01880 NOTE: It is very important you make a copy of the entire completed application for your own records and for us before sending it to the Board as you will need copies of them for any Massachusetts medical institution you apply for privileges at. Once you submit your application, check in frequently with them to ask if any additional documentation is needed. Massachusetts Controlled Substance Certificate: You cannot apply for this until you have your full Massachusetts license. Information on how to apply will be included with Board of Registration materials when they send you your full license. w.pdf Federal DEA Certificate: The toll free telephone number for New England Division is: 1-888-2725174 for any DEA registration related issue. You can apply on-line at: If you already have a DEA from another state, you need to have it updated to reflect your address at Tufts Medical Center. We appreciate your assistance in completing the necessary applications and providing the necessary documentation (e.g. board certificate, federal/state DEA registration, MA medical license) to us in an expeditious manner. We expect that you will return these completed applications and required documents within two weeks of receipt. We are including two reference form letters and two self addressed envelopes. Please have your references complete the forms and return to Medical Staff Office at the address indicated on the end of the form. Please feel free to contact Linda Nolan, Director, Medical Staff Office, Tufts Medical Center at 617636-7652 or Gianna Papa, Manager, Provider Enrollment, PTNEMC at 617-636-2546 if you have any questions or need assistance.

Revised 12/08

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