Provider Demographics
NPI:1629151287
Name:MARION A QUINN MD INC
Entity Type:Organization
Organization Name:MARION A QUINN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-793-7790
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:#164
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106
Mailing Address - Country:US
Mailing Address - Phone:626-793-7790
Mailing Address - Fax:626-793-9018
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:#164
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106
Practice Address - Country:US
Practice Address - Phone:626-793-7790
Practice Address - Fax:626-793-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26112207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7406Medicare PIN