Provider Demographics
NPI:1629295951
Name:ROBERT D. MCQUISTON, M.D., INC
Entity Type:Organization
Organization Name:ROBERT D. MCQUISTON, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAPRILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-887-6707
Mailing Address - Street 1:8216 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6013
Mailing Address - Country:US
Mailing Address - Phone:317-887-6707
Mailing Address - Fax:317-887-5470
Practice Address - Street 1:8216 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6013
Practice Address - Country:US
Practice Address - Phone:317-887-6707
Practice Address - Fax:317-887-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022807A207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN065020AMedicare ID - Type Unspecified
IND67821Medicare UPIN