Provider Demographics
NPI:1720124969
Name:O'QUINN, BRIAN (BS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:O'QUINN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BURLINS DRIVE
Mailing Address - Street 2:P.O. BOX 943
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0943
Mailing Address - Country:US
Mailing Address - Phone:276-865-5531
Mailing Address - Fax:
Practice Address - Street 1:133 MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-0309
Practice Address - Country:US
Practice Address - Phone:276-926-1680
Practice Address - Fax:276-926-9719
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator