Healthcare Provider Details

I. General information

NPI: 1174694442
Provider Name (Legal Business Name): DANIEL M. QUIRK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S 10TH ST 480 MAIN BUILDING
PHILADELPHIA PA
19107-5244
US

IV. Provider business mailing address

132 S 10TH ST 480 MAIN BUILDING
PHILADELPHIA PA
19107-5244
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-955-5245
Mailing address:
  • Phone: 215-955-8900
  • Fax: 215-955-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD434664
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: