Provider Demographics
NPI:1497997894
Name:DAGI, TEODORO FORCHT (MD)
Entity Type:Individual
Prefix:DR
First Name:TEODORO
Middle Name:FORCHT
Last Name:DAGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T. FORCHT
Other - Middle Name:
Other - Last Name:DAGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH, FACS, FCCM
Mailing Address - Street 1:423 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1301
Mailing Address - Country:US
Mailing Address - Phone:617-301-0404
Mailing Address - Fax:617-266-3619
Practice Address - Street 1:423 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1301
Practice Address - Country:US
Practice Address - Phone:617-301-0404
Practice Address - Fax:617-266-3619
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0325432086S0102X, 207T00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine