Provider Demographics
NPI:1831623800
Name:MCQUILLAN, STEPHEN PATRICK (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:MCQUILLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8087
Mailing Address - Country:US
Mailing Address - Phone:651-461-2255
Mailing Address - Fax:
Practice Address - Street 1:5410 MARYLAND WAY STE 400
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8087
Practice Address - Country:US
Practice Address - Phone:651-461-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20926207R00000X
SC92576207R00000X
CT77564207R00000X
MA1019995207R00000X
VA0102208604207R00000X
NY295205207R00000X
PAOS023528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine