Provider Demographics
NPI:1093762734
Name:WERTH, STEPHEN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GREGORY
Last Name:WERTH
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 1:300 CONGRESS ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0907
Mailing Address - Country:US
Mailing Address - Phone:617-773-7431
Mailing Address - Fax:617-773-9592
Practice Address - Street 1:300 CONGRESS ST
Practice Address - Street 2:SUITE 408
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0907
Practice Address - Country:US
Practice Address - Phone:617-773-7431
Practice Address - Fax:617-773-9592
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73556207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology