Provider Demographics
NPI:1205911898
Name:QUILLIN, ANDREW D (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:QUILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH74529207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000122316OtherANTHEM
OH000000122316OtherANTHEM
OHG76971Medicare UPIN