Provider Demographics
NPI:1013256767
Name:AFFAN QUADRI MD PA
Entity Type:Organization
Organization Name:AFFAN QUADRI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-298-2272
Mailing Address - Street 1:705 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-4025
Mailing Address - Country:US
Mailing Address - Phone:904-298-2272
Mailing Address - Fax:904-298-2282
Practice Address - Street 1:705 FERRIS ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4025
Practice Address - Country:US
Practice Address - Phone:904-298-2272
Practice Address - Fax:904-298-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU09018YMedicare UPIN