MEDICARE: RAYFORD EDWIN QUINN M.D.

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	207Q00000X	Family Medicine Physician	18983	NC
2	207Q00000X	Family Medicine Physician	6407	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00721743	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538156153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYFORD EDWIN QUINN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 118008
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29423-8008
Country	:	US
Telephone Number	:	834-572-7727
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTRE RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5881

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/15/2011

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