Provider Demographics
NPI:1265411417
Name:MCQUADE, COLLEEN R (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:R
Last Name:MCQUADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 COUNTY ROAD 101
Mailing Address - Street 2:SUITE 202
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9306
Mailing Address - Country:US
Mailing Address - Phone:352-205-8027
Mailing Address - Fax:352-430-1437
Practice Address - Street 1:11834 COUNTY ROAD 101
Practice Address - Street 2:SUITE 202
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9306
Practice Address - Country:US
Practice Address - Phone:352-205-8027
Practice Address - Fax:352-430-1437
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00269173OtherRAILROAD RETIREMENT BOARD
FL46831OtherBCBS PROVIDER NUMBER
FLG97793Medicare UPIN
FL46831WMedicare ID - Type UnspecifiedPROVIDER NUMBER