Provider Demographics
NPI:1235146242
Name:QUARANTILLO, EDWARD PAUL III (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PAUL
Last Name:QUARANTILLO
Suffix:III
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 1:81 WAR MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411
Mailing Address - Country:US
Mailing Address - Phone:304-258-8805
Mailing Address - Fax:304-258-8846
Practice Address - Street 1:81 WAR MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411
Practice Address - Country:US
Practice Address - Phone:304-258-8805
Practice Address - Fax:304-258-8846
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0054791000Medicaid
F64049Medicare UPIN
0814933Medicare ID - Type Unspecified