Provider Demographics
NPI:1104837558
Name:QUINN, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-433-5309
Mailing Address - Fax:937-433-1340
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-433-5309
Practice Address - Fax:937-433-1340
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1362-Q207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH349754OtherANTHEM
OH4013933OtherAETNA
OH458955Medicaid
OHP00444052OtherMEDICARE ID
OHB95426Medicare UPIN
OH349754OtherANTHEM
OH4022934Medicare ID - Type Unspecified