Provider Demographics
NPI:1588814297
Name:IMAM, TOUFIC (MD)
Entity Type:Individual
Prefix:
First Name:TOUFIC
Middle Name:
Last Name:IMAM
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 1:160 S RIVER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6927
Mailing Address - Country:US
Mailing Address - Phone:603-665-5160
Mailing Address - Fax:603-665-5160
Practice Address - Street 1:160 S RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6927
Practice Address - Country:US
Practice Address - Phone:603-665-5160
Practice Address - Fax:603-665-5160
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449241208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT192321OtherMEDICAL TRAINING LICENSE NUMBER