Provider Demographics
NPI:1982667374
Name:QUINN, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:QUINN
Suffix:
Gender:M
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101024719207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
08247800000OtherQUALCHOICE
MD286071600Medicaid
WV0087193000Medicaid
MD550941600OtherMD MEDICAID GRP
C00085OtherVA MEDICARE B - GROUP #
WV3810003817OtherWV MEDICAID GROUP
44156OtherSENTARA PROFESSIONAL
001717437OtherWV BLUE SHIELD
VA006084176Medicaid
015053OtherANTHEM PROFESSIONAL
2119648OtherMAMSI PROFESSIONAL
000875693OtherWV BLUE SHIELD - GROUP #
VA006084176Medicaid
VA111951528Medicare PIN