Healthcare Provider Details

I. General information

NPI: 1649227208
Provider Name (Legal Business Name): TIMOTHY EDWARD QUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2711
US

IV. Provider business mailing address

1504 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2711
US

V. Phone/Fax

Practice location:
  • Phone: 860-432-8400
  • Fax: 860-432-8430
Mailing address:
  • Phone: 860-432-8400
  • Fax: 860-432-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number037380
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: