Basic Information
| Provider Information | |||||||||
| NPI: | 1962588574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCQUADY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MARKET ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125035100 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471306016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122882488 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 15528 | KY | N | Other Service Providers | Specialist | 207RA0401X | 01079670A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207V00000X | 01079670A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | K177821 | 01 | KY | MEDICARE KY | OTHER | 300010808 | 05 | IN | MEDICAID | IN3604023 | 01 | IN | MEDICARE PTAN | OTHER | 01079670A | 01 | IN | STATE LICENSE | OTHER |