Provider Demographics
NPI:1861480956
Name:QUINN, COLLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:38 LAROSE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3452
Practice Address - Country:US
Practice Address - Phone:518-824-8181
Practice Address - Fax:833-819-0268
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY212477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02347368Medicaid
NY02347368Medicaid
H21700Medicare UPIN
NYDD5290Medicare ID - Type Unspecified