Provider Demographics
NPI:1497828412
Name:MCQUAID, ROBERT GERARD (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GERARD
Last Name:MCQUAID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 PEARL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6644
Mailing Address - Country:US
Mailing Address - Phone:781-665-9500
Mailing Address - Fax:781-665-3856
Practice Address - Street 1:405 PEARL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6644
Practice Address - Country:US
Practice Address - Phone:781-665-9500
Practice Address - Fax:781-665-3856
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S31460Medicare UPIN