Provider Demographics
NPI:1487120606
Name:QUIRK, DANIEL III (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:QUIRK
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6522
Mailing Address - Country:US
Mailing Address - Phone:884-671-1178
Mailing Address - Fax:
Practice Address - Street 1:201 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6522
Practice Address - Country:US
Practice Address - Phone:888-467-1117
Practice Address - Fax:855-786-6996
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08545363A00000X
SC3167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6613Medicaid