Healthcare Provider Details

I. General information

NPI: 1417935248
Provider Name (Legal Business Name): GREGORY LEE QUICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RIDGE RD
NORFOLK MA
02056-1746
US

IV. Provider business mailing address

32 RIDGE RD
NORFOLK MA
02056-1746
US

V. Phone/Fax

Practice location:
  • Phone: 508-520-1073
  • Fax:
Mailing address:
  • Phone: 508-520-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: