Provider Demographics
NPI:1992741185
Name:QUINN, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL ROAD
Mailing Address - Street 2:STE. 400, BLDG. D
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5414
Mailing Address - Country:US
Mailing Address - Phone:610-431-5131
Mailing Address - Fax:610-738-2564
Practice Address - Street 1:915 OLD FERN HILL ROAD
Practice Address - Street 2:STE. 400, BLDG. D
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-431-5131
Practice Address - Fax:610-738-2564
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050491L2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015895640013Medicaid
G32953Medicare UPIN
PA880241Medicare PIN