Provider Demographics
NPI:1487733507
Name:MURATA, GARY TOSHI (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:TOSHI
Last Name:MURATA
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 1:149 EMERALD ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3611
Mailing Address - Country:US
Mailing Address - Phone:603-354-5454
Mailing Address - Fax:
Practice Address - Street 1:149 EMERALD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3611
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8629208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004685Medicaid
NHRE183501Medicare PIN
B73277Medicare UPIN