MEDICARE: DR. MARION A QUINN MD

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	207N00000X	Dermatology Physician	G26112	CA

General Provider Information

NPI Number	:	1902876907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARION A QUINN MD

Provider Business Mailing Address
First Line	:	625 S FAIR OAKS AVE
Second Line	:	#200
City	:	PASADENA
State	:	CA
Zip	:	91105-2613
Country	:	US
Telephone Number	:	626-793-7790
Fax Number	:	626-793-9018

Provider Business Practice Location Address
First Line	:	625 S FAIR OAKS AVE
Second Line	:	#200
City	:	PASADENA
State	:	CA
Zip	:	91105-2613
Country	:	US
Telephone Number	:	626-793-7790
Fax Number	:	626-793-9018

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	09/26/2011

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