Provider Demographics
NPI:1710177985
Name:GLOTH, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GLOTH
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 1:34 GREENWICH PARK
Mailing Address - Street 2:3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3004
Mailing Address - Country:US
Mailing Address - Phone:617-437-0719
Mailing Address - Fax:
Practice Address - Street 1:34 GREENWICH PARK
Practice Address - Street 2:3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3004
Practice Address - Country:US
Practice Address - Phone:617-437-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine