Provider Demographics
NPI:1700805116
Name:QUINTY, MAUREEN M (NP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:M
Last Name:QUINTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:MILDRAM, HANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:DEPARTMENT OF PULMONARY MEDICINE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-856-1975
Practice Address - Fax:774-441-9660
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110016497AMedicaid
MAP41528Medicare UPIN
MANP349301Medicare PIN