Provider Demographics
NPI:1609262179
Name:MCQUILLEN, DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MCQUILLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-6309
Mailing Address - Country:US
Mailing Address - Phone:609-567-0200
Mailing Address - Fax:609-704-5615
Practice Address - Street 1:3003 ENGLISH CREEK AVE STE C6
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4818
Practice Address - Country:US
Practice Address - Phone:609-481-3185
Practice Address - Fax:609-704-5615
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019488207R00000X
NJ25MB10720200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine