Healthcare Provider Details

I. General information

NPI: 1104004761
Provider Name (Legal Business Name): BRIDGET JOYCE QUINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

IV. Provider business mailing address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-3501
  • Fax: 617-730-0178
Mailing address:
  • Phone: 617-355-3501
  • Fax: 617-730-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number236461
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number236461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: