MEDICARE: KERRY QUINN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA004810	PA

General Provider Information

NPI Number	:	1316448269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY QUINN PA-C

Provider Business Mailing Address
First Line	:	570 N 23RD ST APT 8A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3159
Country	:	US
Telephone Number	:	703-674-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 ACADEMY RD STE 203
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1934
Country	:	US
Telephone Number	:	215-637-3100
Fax Number	:	215-637-7310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	07/22/2019

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Directions to “ KERRY QUINN PA-C” Practice Location

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