Basic Information
| Provider Information | |||||||||
| NPI: | 1104837558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6490 CENTERVILLE BUSINESS PKWY | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374335309 | ||||||||
| FaxNumber: | 9374331340 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 MIAMI VALLEY DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374335309 | ||||||||
| FaxNumber: | 9374331340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35-04-1362-Q | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 349754 | 01 | OH | ANTHEM | OTHER | 4013933 | 01 | OH | AETNA | OTHER | 458955 | 05 | OH | MEDICAID | P00444052 | 01 | OH | MEDICARE ID | OTHER |