Basic Information
| Provider Information | |||||||||
| NPI: | 1134144421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 749 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056610749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028518603 | ||||||||
| FaxNumber: | 8028518313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1878 MOUNTAIN RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | STOWE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056724776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022534853 | ||||||||
| FaxNumber: | 8022532587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 12/31/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 226701 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 042.0010997 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-2161484 | 01 | MA | PHCS | OTHER | 226701 | 01 | MA | CONNECTICARE | OTHER | 04-2161484 | 01 | MA | NORTHEAST HEALTH DIRECT | OTHER | 0037148 | 01 | MA | NEIGHORHOOD HEALTH | OTHER | 04-2161484 | 01 | MA | CONSOLIDATED | OTHER | 04-2161484 | 01 | MA | NORTH AMERICAN PREFERRED | OTHER | 04-2161484 | 01 | MA | UNICARE/GIC | OTHER | 7212746 | 01 | MA | AETNA | OTHER | 1302469 | 05 | MA | MEDICAID | 1458784 | 01 | MA | CIGNA | OTHER | 04-2161484 | 01 | MA | NORTHEAST HEALTHCARE ALLI | OTHER | AA51427 | 01 | MA | HARVARD PILGRIM | OTHER | J29739 | 01 | MA | BCBS MA | OTHER | 000000033487 | 01 | MA | BMC | OTHER | 04-2161484 | 01 | MA | PLAN VISTA | OTHER | 37785 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 486940 | 01 | MA | TUFTS | OTHER | 04-2161484 | 01 | MA | GREAT-WEST | OTHER |