Provider Demographics
NPI:1164429247
Name:QUINN, TIMOTHY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
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 1:2 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3225
Mailing Address - Country:US
Mailing Address - Phone:617-658-9300
Mailing Address - Fax:617-658-9399
Practice Address - Street 1:2 WELLS AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3225
Practice Address - Country:US
Practice Address - Phone:617-658-9300
Practice Address - Fax:617-658-9399
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154160207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169898Medicaid
MA3169898Medicaid
MAA23010Medicare ID - Type Unspecified