Healthcare Provider Details

I. General information

NPI: 1063377281
Provider Name (Legal Business Name): DEVOTED HEALTH INSURANCE COMPANY OF DELAWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 CRESCENT ST STE 202
WALTHAM MA
02453-3425
US

IV. Provider business mailing address

221 CRESCENT ST STE 202
WALTHAM MA
02453-3425
US

V. Phone/Fax

Practice location:
  • Phone: 617-958-1611
  • Fax:
Mailing address:
  • Phone: 617-958-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DARIEL QUINTANA
Title or Position: CHIEF OF MEDICARE MARKETS
Credential:
Phone: 617-958-1611