Provider Demographics
NPI:1922284207
Name:ANDREW D QUILLIN MD DERMATOLOGY LLC
Entity Type:Organization
Organization Name:ANDREW D QUILLIN MD DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-436-7188
Mailing Address - Street 1:170 NORTHWOODS BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:614-436-7188
Mailing Address - Fax:614-436-0323
Practice Address - Street 1:170 NORTHWOODS BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:614-436-7188
Practice Address - Fax:614-436-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH74529207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0854322Medicare PIN