Provider Demographics
NPI:1669465548
Name:QUINN, EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:QUINN
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:ONE SEAGATE SUITE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1992
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2150 W CENTRAL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-2200
Practice Address - Fax:419-479-3258
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0717193Medicaid
OHQU4020192Medicare ID - Type Unspecified
C03415Medicare UPIN