Provider Demographics
NPI:1407185606
Name:QUADRI MEDICAL
Entity Type:Organization
Organization Name:QUADRI MEDICAL
Other - Org Name:QUADRI MEDICAL LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-316-5684
Mailing Address - Street 1:PO BOX 9135
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9135
Mailing Address - Country:US
Mailing Address - Phone:603-893-9784
Mailing Address - Fax:603-089-3888
Practice Address - Street 1:2045 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3932
Practice Address - Country:US
Practice Address - Phone:508-379-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1407185606OtherBCBS
RIQU79574Medicaid
MA110084579AMedicaid
RI1407185606OtherBLUE SHIELD
MA110084579AMedicaid
MA1407185606OtherBCBS