Provider Demographics
NPI:1760624423
Name:GUO, QIAO (MD)
Entity Type:Individual
Prefix:
First Name:QIAO
Middle Name:
Last Name:GUO
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 1:9436 58TH AVE # G4
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5149
Mailing Address - Country:US
Mailing Address - Phone:347-947-7692
Mailing Address - Fax:
Practice Address - Street 1:9436 58TH AVE # G4
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:347-947-7692
Practice Address - Fax:347-947-7680
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60269058207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology