Provider Demographics
NPI:1659352862
Name:QUINTERO, MIGUEL J (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:J
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2052
Mailing Address - Country:US
Mailing Address - Phone:412-488-7454
Mailing Address - Fax:412-488-7795
Practice Address - Street 1:144 S 20TH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2052
Practice Address - Country:US
Practice Address - Phone:412-488-7454
Practice Address - Fax:412-488-7795
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034274L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0653007Medicaid
PA0653007Medicaid
PA569275Medicare PIN