Healthcare Provider Details

I. General information

NPI: 1609957281
Provider Name (Legal Business Name): STUART F QUAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE ST SUITE 4930
BOSTON MA
02130-3446
US

IV. Provider business mailing address

1153 CENTRE ST SUITE 4930
BOSTON MA
02130-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-7489
  • Fax: 617-983-2488
Mailing address:
  • Phone: 617-983-7489
  • Fax: 617-983-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11228
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number11228
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: