Provider Demographics
NPI:1306851720
Name:QUINN, EDMUND P (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:P
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 1:447 MERIDEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-574-5650
Mailing Address - Fax:203-574-7815
Practice Address - Street 1:447 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-574-5650
Practice Address - Fax:203-574-7815
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028629207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001286295Medicaid
CTP01051753OtherRR MEDICARE
CT010028629CT04OtherANTHEM BCBS CT
CT464863OtherWELLCARE
CT001286293Medicaid
CT3V1099OtherHEALTHNET/COMMERCIAL
CT5292106OtherAETNA
CTCHN2624OtherCHN
CT028629OtherCONNECTICARE
CT13-36333OtherAMERICHOICE
CT13-36333OtherUHC
CTP3927308OtherOXFORD
CT010028629CT01OtherANTHEM BLUE CROSS
CT1105254OtherUSA
CTCHN2624OtherCHN
CT001286293Medicaid
CT3V1099OtherHEALTHNET/COMMERCIAL
CTP3927308OtherOXFORD