Provider Demographics
NPI:1518276609
Name:QUIMBY, EDWARD ALLEN JR (RT (R))
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALLEN
Last Name:QUIMBY
Suffix:JR
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-1422
Mailing Address - Country:US
Mailing Address - Phone:207-399-2486
Mailing Address - Fax:
Practice Address - Street 1:21 SUMMER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950-1422
Practice Address - Country:US
Practice Address - Phone:207-399-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERT400050412471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography