Provider Demographics
NPI:1275530701
Name:QUERNER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:QUERNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-271-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6168493OtherMASS HEALTH DIV OF MED SV
751063OtherTUFTS
A56693OtherFIRST SENIORITY
27601OtherCHILDRENS MEDICAL SECURIT
65037OtherHARVARD PILGRIM POS
J02527OtherBS BLUE CARE ELECT
1925271OtherCIGNA HEALTH CARE
MA1925271OtherHEALTHSOURCE
J02527OtherBLUE SHIELD INDEMNITY
65037OtherHARVARD PILGRIM
65037OtherHARVARD PILGRIM PPO
J02527OtherHMO BLUE BLUE CHOICE
0016675OtherNEIGHBORHOOD HEALTH PLAN
MA6168493Medicaid
751063OtherTUFTS BENEFIT ADMINSTRATO
751063OtherTUFTS COMMONWEALTH PPO
110093037OtherRAILROAD MEDICARE
MAJ02527OtherBCBS
65037OtherHARVARD PILGRIM POS
0016675OtherNEIGHBORHOOD HEALTH PLAN