Provider Demographics
NPI:1154841088
Name:QU, GUOQIONG (MD)
Entity Type:Individual
Prefix:
First Name:GUOQIONG
Middle Name:
Last Name:QU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GUOQIONG
Other - Middle Name:KATHERINE
Other - Last Name:QU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3147 137TH ST STE CF
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2667
Mailing Address - Country:US
Mailing Address - Phone:917-563-1111
Mailing Address - Fax:929-352-4214
Practice Address - Street 1:3147 137TH ST STE CF
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2667
Practice Address - Country:US
Practice Address - Phone:332-600-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295268207R00000X, 208D00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice