1306851720 NPI number — DR. EDMUND P QUINN MD

Table of content: DR. EDMUND P QUINN MD (NPI 1306851720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306851720 NPI number — DR. EDMUND P QUINN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINN
Provider First Name:
EDMUND
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306851720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
447 MERIDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-574-5650
Provider Business Mailing Address Fax Number:
203-574-7815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 MERIDEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-574-5650
Provider Business Practice Location Address Fax Number:
203-574-7815
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  028629 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 028629 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001286295 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01051753 . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010028629CT04 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 464863 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001286293 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3V1099 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5292106 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CHN2624 . This is a "CHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 028629 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 13-36333 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 13-36333 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3927308 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010028629CT01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1105254 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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