Provider Demographics
NPI:1659335123
Name:QUINTILIANI, JOSEPH P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:QUINTILIANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3331
Mailing Address - Country:US
Mailing Address - Phone:215-879-2500
Mailing Address - Fax:215-879-6756
Practice Address - Street 1:801 N 66TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3331
Practice Address - Country:US
Practice Address - Phone:215-879-2500
Practice Address - Fax:215-879-6756
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005608-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035940Medicaid
PAD98587Medicare UPIN
PAQU044419Medicare ID - Type Unspecified