Provider Demographics
NPI:1962043760
Name:QUANTUM REHABILITATION MEDICINE
Entity Type:Organization
Organization Name:QUANTUM REHABILITATION MEDICINE
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORISCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-315-6359
Mailing Address - Street 1:PO BOX 6553
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6553
Mailing Address - Country:US
Mailing Address - Phone:443-315-6359
Mailing Address - Fax:
Practice Address - Street 1:12150 ANNAPOLIS RD STE 211
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:410-685-1188
Practice Address - Fax:410-685-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1619002649Medicaid