Provider Demographics
NPI:1538229240
Name:IMGPA, INC.
Entity type:Organization
Organization Name:IMGPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-329-0440
Mailing Address - Street 1:805 EL CAMINO REAL
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2315
Mailing Address - Country:US
Mailing Address - Phone:650-329-0440
Mailing Address - Fax:650-321-3589
Practice Address - Street 1:805 EL CAMINO REAL
Practice Address - Street 2:SUITE B
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2315
Practice Address - Country:US
Practice Address - Phone:650-329-0440
Practice Address - Fax:650-321-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80195ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER