Provider Demographics
NPI:1033287255
Name:TOTH, IMRE G (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRE
Middle Name:G
Last Name:TOTH
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 1:1 ENTERPRISE DR
Mailing Address - Street 2:MAIL STOP 02-06
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ENTERPRISE DR
Practice Address - Street 2:MAIL STOP 02-06
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2125
Practice Address - Country:US
Practice Address - Phone:617-246-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30724207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA65867Medicare UPIN